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Yellow  Fever  Institute,  Bulletins  Nos.  1,  2,  3,  4,  5,  6,  and  7. 

Treasury  Department,  U.  S.  Marine- Hospital  Service, 
WALTER  WYMAN,  Surgeon-General. 


BULLETIN 


ON  . 


Organization  and  Progress  of  the  Institute 


AND 

BULLETINS  FROM  SECTION  A— HISTORY  AND  STATISTICS 
SECTION  C— TRANSMISSION;  AND  SECTION  D — QUAR- 
ANTINE MANAGEMENT  AND  TREATMENT. 


MARCH,  1902. 


WASHINGTON: 

GOVERNMENT  PRINTING  OFFICE. 
1902. 


HENRY  B,  Yl 

STATE  UNIVE 


Yellow  Fever  Institute,  Bulletins  Nos.  1,  2,  3,  4,  5,  6,  and  7. 

Treasury  Department,  IT.  S.  Marine- Hospital  Service, 
WALTER  WTMAN,  Surg  eon- General. 


BULLETIN 

ON 

Organization  and  Progress  of  the  Institute 

AND 

BULLETINS  FROM  SECTION  A— HISTORY  AND  STATISTICS 
SECTION  C— TRANSMISSION;  AND  SECTION  D — QUAR- 
ANTINE MANAGEMENT  AND  TREATMENT. 


MARCH,  1902. 


WASHINGTON: 

GOVERNMENT  PRINTING  OFFICE. 

1902. 


TABLE   OF  CONTENTS. 


Bulletin.  Page. 

No.  1. — Organization  and  Progress  of  Institute.    Minutes         ,  —  5 

Xo.  2. — Why  did  not  New  Orleans  Have  Yellow  Fever  in  Early  Times,  while 

Boston  Did?    Section  A   1 

^*No.  3. — Yellow  Fever  in  Europe  ;  a  General  Historical  Review.    Section  A   5 

Xo.  4. — Yellow  Fever  in  Portugal.    Section  A   9 

Xo.  5. — Yellow  Fever  in  Spain.    Section  A   15 

'  ■  ",  No.  6. — A  Xote  on  Mosquitoes  in  Baggage.    Section  C   1 

Xo.  7. — Yellow  Fever  ;  its  Occurrence  and  Quarantine  Management  at  the  Port  of 

Marseille,  France.    Section  D   1 

3 

% 

■ 


NOTE. 

Though  combined,  for  the  sake  of  economy,  in  one  volume,  the  several  bulletins 
herein  published  have  been  prepared  with  a  view  to  binding  at  the  end  of  the  cal- 
endar year  with  other  bulletins  which  are  to  follow.  While  the  bulletin  numbers 
are  consecutive  and  without  regard  to  section,  it  is  proposed  in  the  annual  volume  to  so 
arrange  them  that  the  bulletins  relating  to  each  section  will  be  bound  together  under 
the  section  headings,  namely,  Sections  A,  B,  C,  and  D. 


YELLOW  FEVER  INSTITUTE, 

Treasury  Department,  U.  S.  Marine-Hospital  Service, 

WALTER  WTMAN,  H.  D.  GEDDINGS, 

Surgeon-General  M.  H.  S.,  Passed  Assistant  Surgeon,  M.  H.  S., 

Chairman.  Secretary. 

Bulletin  No.  1. 
EEPOET  ON  ORGANIZATION  AND  PB.0GKESS  OP  THE  INSTITUTE. 

(Abstract  of  Minutes.) 

MARCH,  1903. 


YELLOW-FEYER  INSTITUTE  OF  THE  U.  S.  MARINE -HOSPITAL  SERYICE. 

In  view  of  the  importance  of  the  definite  determination  of  the  cause, 
means  of  spread,  history  and  statistics,  and  quarantine  management 
and  therapeutic  treatment  of  yellow  fever,  it  was  determined  to  form 
within  the  U.  S.  Marine-Hospital  Service  an  Institute  for  the  investiga- 
tion of  these  problems  and  other  kindred  topics  which  might  be  found 
to  have  a  bearing  on  the  questions  as  investigations  proceeded. 

The  prime  object  of  the  organization  is  to  stimulate  the  spirit  of 
scientific  investigation  among  officers  of  the  corps  and  to  secure  the 
cooperation  of  all  who  are  interested  in  the  solution  of  these  very 
important  questions. 

On  September  13,  1901,  a  plan  of  organization  was  submitted  to  the 
honorable  Secretary  of  the  Treasury,  which,  receiving  his  approval, 
led  to  the  organization  of  the  Institute,  with  an  executive  board,  con- 
stituted as  follows  : 

CHAIRMAN  OF  THE  INSTITUTE. 

The  Surgeon-General  of  the  U.  S.  Marine-Hospital  Service. 

SECRETARY. 

Passed  Asst.  Surg.  H.  D.  Geddings,  M.  H.  S.,  in  Charge  of  the  Bureau  Division  oi 
Scientific  Research. 

CHAIRMEN  OF  SECTIONS. 

Sfxtion  A.— History  and  Statistics.— Chairman,  Surg.  George  T.  Yaughan,  M.  H.  S.r 
In  Charge  of  Bureau  Division  of  Sanitary  Reports  and  Statistics. 

SECTION  B— Etiology.— Chairman,  Passed  Asst.  Surg.  M.  J.  Rosenau,  M.  H.  S., 
Director  of  the  Hygienic  Laboratory,  M.  H.  S. 

Section  C— Transmission.— Chairman,  Surg.  J.  H.  White,  M.  H.  S.,  In  Charge  of 
Bureau  Division  of  Domestic  Quarantine. 

5 


Minutes. 


6 


Section  D — Quarantine  and  Treatment. — Chairman,  Surg.  R.  M.  Woodward,  M.  H.  S., 
In  Charge  of  Bureau  Division  of  Foreign  Quarantine  and  Immigration. 

October  11,  1901. — The  first  meeting  of  the  executive  board,  composed 
under  the  terms  of  the  plan  of  organization  of  the  above  chairman,  sec- 
retary and  chairmen  of  sections,  was  held,  all  the  members  being  pres- 
ent, and  the  plans  for  securing  information  and  carrying  out  the  plans 
of  the  Institute  were  discussed.  It  was  agreed  without  dissenting  voice, 
that  it  was  necessary  to  investigate  all  theories  as  to  the  origin  and 
spread  and  methods  of  transmission  of  yellow  fever. 

At  a  meeting  held  October  19,  1901,  Professors  Welch,  Osier,  Abbott, 
McFarlaud,  Flexner,  Barker,  Vaughan  (Victor  C),  John  Guiteras,  and 
Drs.  Eavenel,  Flint,  Theobald  Smith,  and  Carlos  Finley  were  proposed 
for  membership  in  the  Institute  and  duly  elected. 

The  secretary  was  instructed  to  send  to  the  chief  quarantine  officers  of 
Cuba  and  Porto  Rico  additional  copies  of  the  plan  of  organization  of 
the  Institute,  and  to  request  them  to  submit  for  consideration  as  possible 
members  of  the  Institute  the  names  of  persons  within  their  territory 
whom  it  was  thought  might  from  taste  or  previous  work  be  valuable 
members. 

The  secretary  was  also  instructed  to  prepare  a  form  of  invitation  to 
pathologists  and  bacteriologists  to  enroll  themselves  as  members  of  the 
Institute,  and  to  prepare  and  submit  for  approval  a  form  of  invitation 
to  foreign  scientists,  to  unite  themselves  with  the  Institute  as  corre- 
sponding members. 

The  subject  of  the  preparation  and  publication  of  bulletins  was  dis- 
cussed, but  action  was  deferred. 

The  Institute  was  informed  of  the  appointment  by  the  Orleans  Parish 
Medical  Society,  of  New  Orleans,  La.,  of  a  commission  to  investigate 
and  report  upon  the  subject  of  the  mosquitoes  of  New  Orleans  and 
vicinity,  and  their  relation  to  the  questions  of  malaria  and  yellow  fever. 

The  secretary  was  directed  to  extend  invitations  to  membership  to  all 
State  health  officers,  or  secretaries  of  State  boards  of  health. 

It  was  resolved  to  communicate  with  the  Surgeon -General  of  the 
United  States  Army  and  Navy,  with  a  view  of  enlisting  the  aid  and 
cooperation  of  medical  officers  of  the  Army  and  Navy. 

November  5,  1901. — At  the  meeting  of  the  executive  board  of  the 
Institute  the  secretary  reported  that  up  to  this  time  replies  as  to  mem- 
bership in  the  Institute  had  been  received  from  36  officers  of  the  Marine- 
Hospital  Service,  and  that  replies  accepting  membership  had  been 
received  from  64  others,  and  that  among  these  were  Dr.  Benjamin  Lee, 
president  of  the  State  board  of  health  of  Pennsylvania,  and  Dr.  John  S. 
Fulton,  president  of  the  State  board  of  health  of  Maryland. 

The  chairman  called  attention  to  the  fact  that  in  the  library  there 
were  reports  showing  that  in  the  past  there  had  been  use  made  of  petro- 
leum upon  the  streets  and  in  the  gutters  of  New  Orleans  and  Mobile, 
with  apparently  no  very  well  defined  end  in  view,  but,  as  the  results 


7 


Minutes. 


showed  an  escape  from  a  visitation  of  yellow  fever  subsequent  to  the 
procedure,  he  thought  that  the  matter  had  some  significance. 

The  chairmen  of  the  various  sections  then  made  reports  upon  the 
plans  of  orgainization  of  work  in  their  sections,  which  they  stated  were 
tentative,  and  which  were  received  as  information. 

Dr.  Eosjenau  invited  attention  to  the  fact  that  under  the  topic  of  the 
transmission  of  yellow  fever  the  mosquito  alone  had  received  attention. 
He  proposed  the  following  additional  topic,  viz,  4 'Can  the  disease  be 
conveyed  by  any  other  insect,  such  as  the  flea,  fly,  bedbug,  etc." 

November  12,  1901. — At  a  meeting  of  the  executive  board,  Dr.  Kosenau 
reported  that  Professor  Howard  had  informed  him  that  he  was  at 
present  engaged  in  making  a  study  of  the  geographical  distribution  of 
mosquitoes  in  the  United  States,  and  would  be  glad  to  communicate  his 
results  when  completed,  for  the  use  of  the  Institute. 

Letters  were  then  read  from  the  Surgeons- General  of  the  United  States 
Army  and  Navy,  acknowledging  receipt  of  communications  from  the 
Institute,  and  giving  assurance  of  their  interest  in  its  work,  and  pledg- 
ing themselves  to  cooperation  in  the  matter  of  furnishing  reports,  etc. 

The  secretary  was  directed  to  extend  invitations  to  membership  to  the 
president  and  secretary  of  the  American  Medical  Association,  and  to 
the  president  and  secretary  of  the  section  on  hygiene  and  sanitary 
science  of  the  said  association,  also  the  members  of  the  committee  on 
the  etiology  of  yellow  fever  of  the  American  Public  Health  Association. 

The  chairman  then  read  a  letter  which  he  had  prepared  for  the 
approval  of  the  Secretary  of  the  Treasury,  dissolving  the  former  yellow 
fever  commission  of  the  Marine- Hospital  Service,  the  Institute  super- 
seding it. 

The  secretary  then  read  a  letter  from  Dr.  Joseph  Y.  Porter,  the  State 
health  officer  of  Florida,  in  relation  to  the  influence  of  the  mosquito  in 
the  spread  of  yellow  fever.  He  also  invited  attention  to  certain  epi- 
demic incidents  in  Jacksonville  and  Key  West,  and  suggested  inquiry. 
The  matters  were  discussed,  but  no  definite  conclusion  was  arrived  at. 

The  secretary  was  directed  to  prepare  a  syllabus  showing  the  status 
of  the  question  of  the  transmission  of  yellow  fever  from  the  point  of 
view  both  of  the  mosquito  and  fomites,  the  syllabus  to  be  arranged  in 
the  form  of  parallel  columns,  and  showing  the  arguments  and  evidence 
pro  and  con,  adduced  for  each  contention. 

The  chairman  of  Section  A  presented  a  map  which  he  suggested  for 
use  iri  the  preparation  of  maps  showing  the  prevalence  of  yellow  fever 
in  the  United  States,  and  also  for  showing  graphically  the  area  of  infect- 
ive and  noninfectible  territory. 

A  letter  was  read  from  Acting  Assistant  Surgeon  Hodgson,  express- 
ing a  desire  to  be  stationed  in  Vera  Cruz  for  the  purpose  of  conducting 
experiments  in  the  treatment  of  yellow  fever.  It  was  determined  to 
comply  with  the  request  of  Dr.  Hodgson  at  the  earliest  possible  moment. 

An  offer  of  a  paper  by  Surgeon  Carter  on  the  infection  of  ships  by 
yellow  fever  was  then  read,  and  Dr.  Carter's  offer  was  accepted. 


Minutes. 


8 


December  3,  1901. — At  a  meeting  of  the  Executive  Board  letters  were 
read  from  Asst.  Surg.  E.  H.  von  Ezdorf  and  Passed  Asst.  Surg.  G.  M. 
Guit6ras,  nominating  certain  gentlemen  as  members  of  the  Institute. 
Upon  motion  they  were  elected  as  members,  and  the  secretary  was 
instructed  to  so  notify  them. 

A  report  was  received  from  Acting  Asst.  Surg.  Owen  -W.  Stone, 
relative  to  an  epidemic  of  yellow  fever  at  Greenville,  Miss.,  in  1878, 
supposed  to  have  originated  from  infected  baggage  from  New  Orleans. 

The  chairman  of  Section  B  offered  to  the  Institute  for  use  as  a 
bulletin  a  report  by  Assistant  Surgeon  Grubbs  on  "  Mosquitoes  in  Bag- 
gage," which  the  secretary  was  ordered  to  prepare  for  publication. 

January  21,  1902. — A  proposition  was  received  from  Drs.  O.  L.  Pothier 
and  George  E.  Beyer,  of  New  Orleans,  La.,  offering  to  place  themselves  at 
the  disposal  of  the  Institute  and  the  Service,  with  a  view  of  continuing 
the  work  which  they  had  already  done,  as  members  of  the  Orleans  Parish 
Mosquito  Commission,  said  work  to  be  in  the  interest  and  on  behalf  of 
the  Institute  of  which  they  are  members. 

Discussion  followed,  in  which  it  was  agreed  that  it  would  be  advan- 
tageous to  engage  the  services  of  these  gentlemen,  and  to  associate  with 
them  Asst.  Surg.  H.  B.  Parker,  M.  H.  S.,  the  three  to  constitute  a 
working  party,  who  would  proceed  to  some  point  in  Mexico  or  South 
America,  when  and  where  yellow  fever  might  make  its  appearance,  for 
the  purpose  of  continuing  the  work  inaugurated  by  the  New  Orleans 
commission.  It  was  directed  that  Drs.  Pothier  and  Beyer  be  communi- 
cated with,  and  a  definite  proposition  obtained  from  them. 

It  was  further  agreed  that  it  would  be  advisable  to  station  an  officer 
for  purposes  of  observation  in  Habana,  Cuba,  and  the  Surgeon- General 
M.  H.  S.,  was  requested,  if  possible,  to  detail  Asst.  Surg.  D.  H.  Currie 
for  the  purpose,  he  having  received  special  training  which  wduld  fit  him 
for  the  detail. 

Attention  was  also  called  to  the  presence  of  the  French  commission 
for  the  investigation  of  the  cause  of  yellow  fever,  which  was  at  present 
located  at  Petropolis,  in  Brazil. 

It  was  further  agreed  that  it  would  be  advisable  to  keep  informed  as 
to  the  prevalence  of  yellow  fever  on  the  west  coast  of  Africa  (Senegal), 
with  a  view  to  dispatching  another  worker  or  party  to  that  point. 

Information  was  also  elicited  to  the  effect  that  the  services  of  Acting 
Assistant  Surgeon  Gregory,  who  is  now  undergoing  instruction  in  the 
Hygienic  Laboratory,  and  whom  it  was  intended  to  dispatch  to  Bio  de 
Janeiro,  would  be  of  value  in  enabling  him  to  report  upon  such  tran- 
sactions of  the  French  commission  as  might  come  to  his  notice. 

A  report  was  read  from  the  consul  at  Marseille,  France,  showing  the 
quarantine  management  of  yellow  fever  at  that  port,  and  giving  statis- 
tics of  the  disease  for  past  years. 

January  29,  1902. — At  a  meeting  of  the  executive  board,  the  secretary 
read  a  communication  received  from  Drs.  Pothier  and  Beyer  of  New 
Orleans,  in  which  they  expressed  a  perfect  willingness  to  have  Dr. 


9 


Minutes. 


Parker  associated  with  them,  and  in  which  they  also  proposed  terms, 
etc.  These  terms  and  proposed  arrangements  being  considered  reason- 
able and  advantageous,  it  was  resolved  that  the  Surgeon-General  Marine- 
Hospital  Service  be  requested  to  have  Drs.  Pothier  and  Beyer  appointed 
temporary  acting  assistant  surgeons  for  the  purpose,  and  on  the  terms 
named  by  them.  The  question  of  the  publication  of  bulletins  was  again 
brought  before  the  meeting,  and  it  was  decided  informally  that  an 
effort  should  be  made  to  prepare  a  general  bulletin  showing  the  progress 
of  organization,  and  that  this  should  be  succeeded  by  special  bulletins, 
showing  the  work  of  the  various  sections,  material  for  some  of  these 
special  bulletins  being  now  in  the  hands  of  the  secretary  and  further 
additions  being  promised. 

February  14.,  1902. — At  a  meeting  held  this  day  the  names  of  Dr. 
Pedro  J.  Salicrup  and  Dr.  Antonio  Molina,  of  Ponce,  P.  R.,  were 
submitted  for  membership  by  letter  from  Asst.  Surg.  W.  W.  King,  and 
upon  motion  duly  seconded  they  were  elected  to  membership.  Upon 
motion  duly  seconded,  Dr.  George  H.  F.  Nuttall,  of  Cambridge,  Eng- 
land, was  invited  to  membership  in  the  Institute,  and  the  secretary  was 
instructed  to  convey  notice  of  the  invitation  to  him  by  letter. 

Upon  motion  made  and  duly  seconded,  the  following  foreign  scientists 
were  invited  to  enroll  themselves  as  corresponding  members  of  the 
Institute:  Drs.  N.  del  Rio,  Manuel  Iglesias,  and  Z.  Molina,  of  Vera 
Cruz,  Mexico:  Prof.  Guiseppe  Sanarelli,  of  the  University  of  Bologna, 
Italy  ;  Dr.  Catalan,  chief  of  quarantine,  of  Marseille,  France ;  Professor 
Proust,  Inspector  General  of  the  Sanitary  Service  of  the  Republic  of 
France;  Professor  Wurtz.  of  the  School  of  Medicine,  Paris,  France; 
Dr.  E.  Liceaga,  President  of  the  Superior  Board  of  Health  of  Mexico  ; 
Dr.  Frederick  Montizambert,  Director  General  of  Public  Health,  Ottawa, 
Ontario ;  Dr.  W.  Havelburg,  of  Berlin,  Germany  ;  Prof.  R.  Blanchard, 
of  the  Faculty  of  Medicine,  Paris,  France,  and  Professor  Dunbar,  of  the 
Hygienic  Institute,  Hamburg,  Germany. 

Dr.  Yaughan  then  reported  that  he  had  received  from  Assistant 
Surgeon  Glover,  at  Boston,  Mass. ,  a  contribution  on  the  question  ' '  Why 
Did  Not  New  Orleans  have  Yellow  Fever  in  Early  Times,  while  Boston 
Did,'-'  and  suggested  its  publication  as  a  special  bulletin  from  Section  A, 
which  was  so  ordered.  He  further  reported  that  he  was  in  receipt  of 
two  papers  from  Passed  Asst.  Surg.  J.  M.  Eager,  at  Naples,  Italy,  one 
being  a  general  history  of  yellow  fever  in  Europe,  the  other  a  history 
of  the  disease  in  Portugal,  with  a  promise  of  further  contributions  on 
the  subject  of  the  disease  in  other  countries  in  Europe.  He  suggested, 
and  it  was  ordered,  that  these  be  published  also  as  special  bulletins. 

Surgeon  White  reported  that  as  chairman  of  Section  C  he  was  in 
receipt  of  a  contribution  from  Surg.  H.  R.  Carter  on  the  subject  of 
the  infection  of  ships  by  yellow  fever — the  result  of  personal  observa- 
tions. After  considerable  discussion  it  was  agreed  that  the  article 
should  be  offered  to  a  medical  journal  for  publication,  and  that  it  should 
subsequently  appear  as  a  special  bulletin  of  the  Institute. 


Minutes. 


10 


The  chairman  of  Section  D  reported  that  a  letter  had  been  addressed 
through  the  Treasury  Department  to  the  Department  of  State,  request- 
ing that  the  consuls  in  various  Central  and  South  American  districts  be 
requested  to  give  early  telegraphic  notice  of  the  appearance  of  yellow 
fever  in  their  localities,  in  order  that  the  Institute  might  make  proper 
arrangements  to  dispatch  its  working  parties  to  the  scene  of  the  out- 
break. 

February  26,  1902. — The  secretary  reported  that  in  the  matter  of  the 
invitations  to  foreign  scientists  to  enroll  themselves  as  corresponding 
members,  it  had  been  deemed  expedient  by  the  Surgeon- General  to 
request  the  Secretary  of  the  Treasury  to  ask  the  opinion  of  the  Depart- 
ment of  State  as  to  the  propriety  of  issuing  invitations  to  such  gentle- 
men, several  of  whom  were  actually  officials  under  their  various  govern- 
ments. The  matter  was  therefore  held  in  abeyance,  pending  the  receipt 
of  this  decision,  but  a  reply  having  been  received  from  the  Secretary  of 
State,  stating  that  the  proposed  action  was  in  accord  with  official  pro- 
priety, the  invitations  were  subsequently  duly  dispatched. 

The  secretary  further  reported  that  a  reply  had  been  received  from 
the  Department  of  State,  saying  that  in  accordance  with  request,  the 
consuls  at  Eio  de  Janeiro,  Santos,  and  Vera  Cruz  had  been  instructed  to 
cable  information  of  the  first  appearance  of  yellow  fever  in  their  districts. 

The  Surgeon  General  was  requested  to  take  the  necessary  preliminary 
steps  toward  having  Drs.  Beyer  andPothier,  of  New  Orleans,  nominated 
in  due  form  as  acting  assistant  surgeons,  in  order  that  there  might  be 
no  delay  in  dispatching  them  when  an  outbreak  of  yellow  fever  made 
the  employment  of  their  services  desirable. 

A  discussion  followed  on  the  most  recent  announcement  by  Drs.  Eeid 
and  Carroll  of  their  work  on  the  etiology  of  yellow  fever,  who  announced 
as  a  result  of  their  experiments,  that  the  causative  organism  of  yellow 
fever  was  ultra- microscopical. 

While  all  officers  of  the  Marine-Hospital  Service  are  de  facto  members, 
at  this  time  the  Institute  has  as  members  55  officers  of  the  Marine- 
Hospital  Service,  who  have  formally  given  notice  of  their  cooperation. 
Assurances  of  cooperation  have  been  received  from  the  Surgeons-General 
of  the  United  States  Army  and  Navy,  and  in  addition  to  those  invited 
and  enrolled  as  corresponding  members,  over  100  invitations  to  mem- 
bership have  been  issued  and  acknowledged,  including  bacteriologists 
and  pathologists,  secretaries  and  executive  officers  of  State  and  local 
boards  of  health,  the  president  and  secretary  of  the  American  Medical 
Association,  and  the  chairman  and  secretary  of  the  section  of  hygiene 
and  sanitary  science  of  the  same  association,  members  of  the  committee 
on  the  etiology  of  yellow  fever  of  the  American  Public  Health  Asso- 
ciation, and  physicians  in  all  parts  of  the  United  States,  Cuba,  and 
Porto  Rico. 

The  names  of  all  those  elected  to  membership  are  not  included  in  the 
foregoing  transcript,  but  in  a  subsequent  bulletin  there  will  appear  a 
full  list  of  the  regular  and  corresponding  members  of  the  Institute. 


YELLOW  FEVER  INSTITUTE, 

Treasury  Department,  U.  S.  Marine-Hospital  Service, 
WALTER  WYMAN,  Surgeon-General. 

Bulletin  No.  2. 


Section  A.— HISTORY  AND  STATISTICS.  Surg.  GEORGE  T.  VAUGHAN,  Chairman  of  Section. 


YELLOW  FEVER— WHY  DID  NOT  NEW  ORLEANS  HAVE  INVASIONS  OF 
THE  DISEASE  IN  EARLY  TIMES,  WHILE  BOSTON  DID  ? 

By  M.  W.  Glover,  Assistant  Surgeon,  M.  H.  S. 


MARCH,  1902. 


YELLOW  FEVER— WHY  DID  NOT    NEW  ORLEANS   HAVE    IT  IN  EARLY 
TIMES,  WHILE  BOSTON  DID  % 

In  the  consideration  of  this  snbject  it  is  necessary,  first  to  ascertain 
the  date  of  the  primiary  visitation  of  yellow  fever  in  the  two  cities. 
After  a  careful  examination  of  the  authorities,  one  arrives  at  the  con- 
clusion that  the  first  undoubted  visit  of  yellow  fever  to  Boston  was  in 
1798.  In  1693  the  following  circumstances,  quoted  from  Hutchinson, 
have  given  rise  to  the  statement  that  yellow  fever  prevailed  in  that 
year  in  Boston.  An  English  fleet  had  been  ordered  from  the  West 
Indies  to  Boston  to  cooperate  with  land  forces  in  an  attack  on  Quebec. 

Before  Sir  Francis  Wheeler  came  to  Boston  with  the  fleet,  June  17, 1693,  he  had  hurried 
1,300  out  of  2,100  sailors,  and  1,800  out  of  2,400  soldiers.  *  *  *  The  distemper, 
which  had  heen  in  the  fleet  spread  to  Boston,  and  was  more  malignant  even  than  the 
smallpox  had  been  or  any  other  epidemical  sickness  which  had  been  in  the  country 
before. 

Chief  Justice  Sewall,  in  his  diary,  also  remarks  on  the  deaths  of 
several  persons  from  the  "  sickness  of  the  fleet." 

On  the  other  hand  Cotton  Mather  in  his  Magnalia,  says  : 
There  was  an  English  fleet  of  our  good  friends,  with  a  direful  plague  aboard, 
intended  hither.    Had  they  come,  as  they  intended,  what  a  horrible  desolation  had 
cut  us  off,  let  the  desolate  places  that  some  of  you  have  seen  in  the  colonies  of  the 
South  declare*unto  us  !    And  that  they  did  not  come,  was  the  signal  hand  of  Heaven. 

1 


Section  A. 


2 


Noah  Webster,  in  his  History  of  Pestilential  and  Epidemic  Diseases 
(1799),  arrives  at  the  following  conclusion  : 

From  this  authentic  history,  written  by  a  contemporary  clergyman,  we  infer  that 
Hutchinson  must  have  made  a  mistake.  Sir  Francis  Wheeler's  fleet  arrived  at  Boston 
most  dreadfully  infected,  but  no  disease  was  propagated  in  Boston.  Some  other  fleet, 
it  seems,  had  introduced  the  disease  into  ' '  a  colony  of  the  South, ' '  perhaps  Newport 
or  New  York,  but  I  have  no  information  on  the  subject. 

Lyman  Spalding,  in  Eeflections  on  Yellow  Fever  Periods  (1819), 
states  that  the  first  appearance  of  yellow  fever  in  Boston  was  on  the  25th 
of  August,  1796,  "in  a  family  at  the  southeasterly  part  of  the  town, 
near  a  considerable  extent  of  flats,  which  are  daily  exposed  for  some 
hours  to  the  action  of  the  sun.  No  mention  is  made  of  importation 
either  by  Dr.  Warren  or  by  Dr.  Brown.  Public  opinion  did  not  even 
accuse  any  vessel  of  having  imported  it."  Noah  Webster  says  that  in 
1796  the  disease  appeared  in  Boston,  but  was  not  general  or  severe. 
"It  spread  only  in  a  small  part  of  the  town  adjoining  the  water.'7  This 
occurrence,  if  of  true  yellow  fever,  was  undoubtedly  sporadic. 

This  brings  us,  then,  to  the  first  undoubted  epidemic  of  yellow  fever 
in  Boston,  which  occurred  in  1798.  With  regard  to  the  origin  of  this 
epidemic,  the  following  statement  is  made  in  Tytler's  Treatise  on 
Plague  and  Yellow  Fever  (1799). 

T«he  origin  of  the  fever  at  Boston  has,  as  usual,  been  disputed,  but  the  common  opin- 
ion is  that  it  was  generated.  It  now  appears,  however,  that,  though  there  are  very 
strong  reasons  for  supposing  it  to  have  originated  in  the  place,  there  are  others  equally 
strong  for  believing  that  it  was  imported.  It  is  ascertained  that  a  vessel,  on  board 
which  persons  had  died  with  the  yellow  fever,  lay  in  the  neighborhood  of  the  family 
first  seized  with  the  disease  in  1798. 

Dr.  Warren  dismisses  the  subject  thus:  "No  person  could  produce 
any  evidence  of  importation  of  this  disease."  Noah  Webster  says  that 
the  fever  showed  most  violent  effects  in  the  region  of  Fort  Hill,  and 
suggests  that  we  may  find  the  cause  in  the  very  extensive  flat  between 
Boston  and  Dorchester  Point,  which  is  uncovered  at  low  water.  In  com- 
mon with  all  the  other  cities  afflicted  by  epidemics  from  1793  to  1804, 
yellow  fever  in  Boston  began  in  the  most  filthy  part  of  the  town.  Mill 
Pond,  one  of  the  foci  of  the  disease,  is  thus  described  by  Samuel  Brown : 

This  pood  is  the  common  receptacle  of  a  great  number  of  dead  dogs,  cats,  and  small 
animals,  besides  large  quantities  of  putrid  meat,  fish,  and  vegetables.  There  also  empty 
the  sewers  and  drains  from  vaults  and  cellars  of  the  buildings  surrounding  the  place. 
This  pond  was  frequently,  during  the  summer,  deprived  of  its  waters,  and  its  naked 
surface  exposed  to  the  excessive  heat  of  the  sun. 

Fever  prevailed  until  the  latter  part  of  October,  when  a  severe  north- 
easter, continuing  for  three  days,  followed  later  by  a  heavy  frost,  com- 
pletely checked  the  disease. 

That  our  forefathers  in  medicine  were  puzzled  by  the  eccentricities 
of  this  disease  there  is  abundant  proof  in  the  literary  remnants  of  a 
bitter  controversy  as  to  whether  yellow  fever  was  imported  or  domestic, 


3 


Section  A. 


whether  it  was  contagious  or  noncontagious.  One  thing  is  to  be  borne 
in  mind  in  considering  the  sporadic  cases  of  the  years  previous  to  1798, 
and  that  is  the  possibility  of  a  mistaken  diagnosis.  We  have  positive 
proof  that  malarial  fevers  were  common  in  New  England  in  the  early 
days  though  now  malaria  is  no  longer  endemic  in  this  region,  possibly 
due  to  the  filling  in  of  stagnant  ponds  and  improved  drainage  facilities. 
In  view  of  all  the  circumstances  we  are  justified  in  considering  1798  as 
the  earliest  appearance  of  yellow  fever  in  Boston. 

Let  us  now  consider  New  Orleans.  This  city  was  founded  by  Bien- 
ville in  1718,  though  it  was  not  until  1722  that  the  capital  was  finally 
established  there.  It  was  not  for  many  years  after  the  settlement  of 
Louisiana  that  the  attention  of  its  people  was  given  to  the  development 
of  its  agricultural  resources,  and  commerce  with  other  countries  entered 
into.  Yellow  fever  seems  to  have  been  unknown  in  New  Orleans  until 
1769,  when  an  outbreak  occurred,  which  was  not  general  and  appears  to 
have  been  sporadic.  In  one  place  a  statement  is  made  that  yellow  fever 
was  introduced  in  this  year  by  a  British  vessel  from  the  coast  of  Africa 
with  a  cargo  of  slaves.  No  confirmation  of  this  statement  could  be 
found,  however.  In  1796,  according  to  Ohaille,  occurred  the  first  epi- 
demic of  yellow  fever,  and  he  considered  the  digging  of  the  Carondelet 
Canal,  begun  in  1794,  as  a  predisposing  factor.  In  a  work  entitled, 
Travels  in  Louisiana  and  the  Floridas,  published  in  1802,  it  is 
stated  that  yellow  fever  was  unknown  in  New  Orleans  prior  to  1796, 
and  "it  is  the  general  opinion  that  the  yellow  fever  at  New  Orleans 
was  imported  from  the  United  States  of  America.  *  *  *  It  is 
thought  to  have  its  origin  from  the  fever  that  committed  its  ravages  at 
Philadelphia  in  1793,  and  that  it  was  brought  to  New  Orleans  by  the 
Americans  themselves,7'  who  engaged  the  greater  part  of  the  trade  of 
New  Orleans. 

From  the  foregoing  it  will  be  seen  that,  disregarding  all  sporadic 
cases,  Boston  had  its  first  epidemic  in  1798,  New  Orleans  in  1796. 
Therefore,  there  was  little,  if  any,  difference  in  the  time  of  the  advent 
of  yellow  fever  in  both  cities.  It  seems  that  both  were  touched  by  the 
great  wave  of  pestilence  that  swept  over  the  country  from  1793  to  1804. 
In  Boston  the  disease  was  as  seed  that  fell  in  stony  places  and,  having 
no  root,  withered  away ;  while  in  New  Orleans  it  was  as  seed  that  fell 
on  good  ground  and  brought  forth  fruit  an  hundredfold,  bearing  its 
yearly  crop  of  deaths  and  desolation. 

If  we  consider  sporadic  cases,  however,  the  conclusions  we  arrive  at 
are  not  materially  different.  In  1691  and  1693,  when  Boston  is  reputed 
to  have  had  yellow  fever,  New  Orleans  did  not  have  it  for  only  one  rea- 
son, and  that  was  the  nonexistence  of  New  Orleans.  From  1718,  the 
date  of  New  Orleans'  birth,  until  1796,  the  first  epidemic  in  tha  city, 
Boston  was  equally  free  from  the  visits  of  the  pestilence. 


YELLOW  FEY  EE  INSTITUTE, 

Treasury  Department,  U.  S  Marine-Hospital  Service. 
WALTER  WYMAN,  Surgeon-General. 

Bulletin  No.  3. 


SectiOD  A. — HISTORY  AND  STATISTICS;  Snrg.  GEORGE  T.  VAUGHAN,  Chairman  of  Section. 


YELLOW  PEVER  IN  EUKOPE-A  GENERAL  HISTORICAL  REVIEW. 

By  J.  M.  Eager,  Passed  Assistant  Surgeon,  31.  H.  S. 

MARCH,  190^. 


YELLOW  FEVER  IN  EUROPE. 

Although  the  fact  is  well  known  that  at  various  times  yellow  fever 
has  gained  a  foothold  in  Europe,  no  adequate  idea  can  be  had  of  its 
widespread  prevalence  at  many  places  where  it  has  been  introduced 
except  by  a  careful  review  of  the  literature  of  the  disease.  The  extent 
of  some  of  these  accidental  epidemics  of  yellow  fever  occurring  outside 
of  the  regions  of  its  periodic  prevalence  is  made  evident  when  it  is 
remembered  that  at  Barcelona,  Spain,  during  the  funereal  epidemic  of 
the  year  1821,  approximately  25,000  persons  died  within  five  months  of 
yellow  fever,  and  that,  at  Lisbon,  Portugal,  during  the  year  1857,  in  an 
epidemic  of  five  months'  duration,  there  were  over  13,000  persons 
stricken  with  the  disease,  the  mortality  being  almost  50  per  cent. 

An  outbreak  of  bubonic  plague  in  a  European  city  as  disastrous  as, 
for  example,  the  yellow  fever  epidemics  mentioned  would  certainly  give, 
rise  to  the  justifiable  apprehension  that  the  disease  was  likely  to  over- 
run the  Continent. 

That  the  mosquito  conveys  the  yellow  fever  infection,  according  to 
the  theory  of  Finlay,  appears  to  be  satisfactorily  proved.  In  event  of 
the  fact  being  further  established  that  the  mosquito  is  the  sole  agent  in 
the  transmission  of  the  infection  of  yellow  fever  from  man  to  man,  it 
would  be  interesting  to  know  what  particular  mosquito  was  instru- 
mental in  the  spread  of  the  disease  after  its  introduction  into  European 
ports.  From  the  review  of  the  literature  of  the  subject,  and  such 
inquiries  as  have  been  made  in  the  preparation  of  this  writing,  it  has 

5 


Section  A. 


6 


been  impossible  to  determine  whether  the  Gulex  fasciatus  of  American 
authors  is  exactly  represented  in  the  description  of  the  European  mos- 
quitoes. Stegomyia  teniati  does  not  appear  in  any  accessible  European 
nomenclature.  A.  Lutz,  director  of  the  municipal  bacteriological  lab- 
oratory of  Sao  Paulo,  Brazil,  after  careful  entomological  examination, 
has  determined  that  the  {South  American  mosquito  described  as  G.  toeni- 
atus  is  the  same  as  G.  fasciatus  of  North  America.  De  Gouvea  states 
that  the  yellow- fever  mosquito  of  America  is  the  same  as  that  occurring 
and  named  in  Southern  Italy  as  G.  elegans,  Ficalbi,  and  in  Portugal  as 
C.  calopus,  Hoffmannii.  It  does  not  appear,  however,  from  the  system- 
atic revision  of  the  culex  family,  made  by  Ficalbi  in  his  latest  work 
(1896),  that  C.  elegans,  Ficalbi,  and  C.  calopus,  Hoffmannii,  are  the 
same.  Miegen  states  that  C.  calopus,  occurs  in  Portugal.  Rondani 
accepts  the  species  for  Italy,  but  does  not  give  a  fall  description.  Ficalbi 
records  that  Stephens  mentions  C.  calopus  in  the  list  of  English  mosqui- 
toes, but  marks  it  with  an  interrogation  point.  Writing  of  G.  elegans, 
Ficalbi  says  that  he  has  found  this  mosquito  in  Italy,  but  not  in  large 
numbers.  He  has  described  the  species  under  the  name  of  G.  elegans, 
because,  after  rigorous  inquiry  he  has  been  unable  to  identify  the  mos- 
quito with  any  described  by  authors  who  had  previously  prepared 
classifications.  Ficalbi  adds  that  he  often  asks  himself  if,  "per  adven- 
ture, G.  elegans  may  not  be  the  G.  calopus  of  Meigen,"  but  is  1  'con- 
strained to  make  a  separate  species  because  of  slight  differences  in  the 
zoological  descriptions.  ■  ? 

In  fixing  upon  the  guilty  mosquito,  there  is  abundant  variety  to 
reckon  on.  Ficalbi,  i  n  the  treatise  mentioned,  describes  60  species  of 
mosquitoes  inhabiting  Europe — 53  belonging  to  the  genus  culex,  5  to 
anopheles,  and  2  to  aedes. 

Should  it  be  found  on  careful  comparison  that  the  American  mosquito 
that  conveys  yellow  fever  does  not  correspond  with  any  European 
member  of  the  culex  family,  there  still  remains  the  possibility  that  a 
European  mosquito  of  a  different  species  may  perform  the  office  of  car- 
rier of  yellow  fever  contagion,  or  that  stowaway  mosquitoes  from  the 
Western  Hemisphere  accompanying  pest  ships  might  be  landed  in 
Europe,  reproduce  their  kind  for  a  few  generations,  and  incidentally 
continue  the  spread  of  yellow  fever. 

Without  taking  into  consideration  the  cases  that  have  occurred  on 
board  vessels  in  ports  and  at  quarantine  stations,  in  Europe,  yellow 
fever  has  at  times  been  present  in  Portugal,  Spain,  France,  the  British 
Isles,  Italy,  and  Austria. 

The  earliest  authentic  appearance  in  Europe  was  in  1723,  at  Lisbon, 
Portugal,  an  epidemic  which  attained  great  proportions.  Portugal  was 
free  from  the  disease  from  that  year  until  1850,  when  there  were  a  few 
cases  at  Oporto.  In  1851  there  were  57  deaths  from  yellow  fever  at 
Oporto.  A  third  epidemic  occurred  at  Oporto  in  1856  and  resulted  in 
120  cases  and  63  deaths.    In  the  year  of  Portugal's  greatest  epidemic  of 


7 


Section  A. 


yellow  fever  (1857)  there  were  at  Lisbon,  where  the  first  focus  formed, 
13,757  persons  sick  with  the  disease,  of  whom  5,652  died.  In  the 
neighboring  city  of  Olivaes  112  cases  of  yellow  fever  occurred.  The 
next  year  a  few  cases  were  reported  in  Portugal  and  the  Azores,  and 
since  then  yellow  fever  is  said  to  have  been  absent  from  the  country. 

Spain  is  the  European  country  whose  yellow  fever  history  is  the  most 
extensive.  It  is  of  practical  bearing  to  note  that  oiten  when  the  most 
rigid  sanitary  precautions  were  being  taken  to  prevent  the  importation 
of  the  disease,  the  contagion  was  introduced  into  Spain  by  smugglers  in 
surreptitious  communication  with  suspected  vessels,  or  clandestinely 
landing  infected  goods,  thus  confirming  by  the  history  of  Spanish  epi- 
demics, the  wisdom  of  the  measures  that  have  of  late  been  taken  by  the 
Marine- Hospital  Service  in  making  a  patrol  of  the  Florida  coast  with  a 
view  to  a  surveillance  of  small  craft  from  West  Indian  waters. 

There  is  no  accredited  record  of  yellow  fever  having  appeared  in  Spain 
prior  to  1738,  when  it  was  imported  into  Cadiz  from  America  and  spread 
to  other  cities  of  Spain.  In  1733,  1741,  1744,  1746,  1749,  and  1753,  epi- 
demics of  greater  or  lesser  severity  prevailed,  that  of  1741  causing 
10,000  deaths.  After  more  than  half  a  century  of  immunity,  an  out- 
break occurred  in  1800,  spread  widely,  and  numbered  17,500  persons  as 
its  victims.  The  next  year  and  the  second  year  after,  the  disease  renewed 
its  ravages.  In  1803,  at  Malaga,  6,884  persons  died  of  yellow  fever.  In 
1804,  there  perished  7,726  persons.  In  the  latter  year,  the  disease 
extended  to  many  cities  of  Spain.  Again,  in  1808,  1810,  1811,  1812,  and 
1814,  there  were  epidemics  of  varying  virulency.  At  Cadiz  in  1819, 
40,000  cases  of  yellow  fever  were  recorded  with  a  mortality  of  20  per 
cent.  The  prevalence  at  Barcelona  in  1821  was  appalling  in  its  results. 
In  five  months,  25,000  persons  died  of  the  disease.  The  infection  spread, 
to  other  cities,  killing  4,500  at  Tortosa,  and  destroying  one-half  the 
inhabitants  of  Palma,  capital  of  the  Balearic  Islands.  In  1823  and  1829, 
the  malady  was  present  in  Spain,  but  afterwards  there  was  an  interval 
of  immunity  extending  to  1870.  During  the  summer  of  1870,  the  con- 
tagion was  introduced  into  Barcelona  and,  in  the  months  of  August  and 
September,  between  25  and  40  persons  fell  prey  each  day  to  the  disease. 
The  latest  recorded  occurrence  in  Spain  was  in  1878,  when  yellow  fever 
invaded  the  capital,  Madrid,  and  attacked  50  persons  of  whom  30  died. 

It  is  stated  in  an  early  history  of  the  city  of  La  Eochelle  that  the  first 
importation  of  yellow  fever  into  France,  and  consequently  into  Europe, 
was  in  1700,  but  the  record  lacks  scientific  authority.  The  first  prop- 
erly verified  occurrence  was  at  Brest,  1802,  when  23  deaths  took  place 
in  the  hospital  of  the  lazaretto,  and  several  cases  broke  out  in  the  city. 
The  same  year  yellow  fever  was  present  in  quarantine  at  Marseille.  At 
Marseille  again  there  were  cases  in  the  city  in  1821,  and  at  Brest  in  the 
harbor  in  1839.  Sanitary  interest,  however,  from  a  yellow  fever  point 
of  view,  is  centered  on  the  epidemic  at  Saint  Nazaire,  in  1861.  A  sailing 
vessel  introduced  the  disease  from  Havana.    The  manner  in  which  it 

2  YF 


Section  A. 


8 


spread  throughout  the  shipping  of  the  port,  infecting  7  other  vessels,  with 
a  result  that  40  persons  fell  ill  of  yellow  fever  and  23  died,  has  led  a 
recent  writer  (de  Gouvea,  Le  Bulletin  Medical,  October  12,  1901)  to 
observe  that  the  facts,  in  his  opinion,  adapt  themselves  perfectly  to  the 
theory  of  the  propagation  of  yellow  fever  by  mosquitoes.  On  different 
occasions,  after  the  epidemic  at  Saint  Nazaire,  yellow  fever  occurred 
on  board  ships  in  French  harbors,  but  did  not  appear  ashore,  except  in 
1870,  when  a  seaman  from  a  pest  ship  died  of  yellow  fever  in  a  civil 
hospital  at  Marseille. 

The  yellow  fever  history  of  the  British  Isles  is  limited  to  5  appear- 
ances of  the  disease  between  the  years  of  1817  and  1865,  in  the  harbors 
of  Falmouth,  Southampton,  and  Swansea. 

At  Leghorn,  in  1801,  yellow  fever  was  introduced  by  a  Spanish  vessel 
from  Alicante  and  Cadiz  where  the  disease  was  epidemic.  The  disease 
prevailed  at  Leghorn  for  four  months,  causing  not  less  than  700  deaths, 
and  according  to  one  author  as  many  as  1900.  At  Torre  Annunziate,  a 
city  of  20,000  inhabitants  situated  in  the  province  of  Naples,  there  was 
in  1883  an  epidemic  prevalence  of  a  disease  which  was  pronounced  by 
several  competent  medical  men  to  have  been  yellow  fever.  Of  13  cases 
presenting  clinical  features  at  least  closely  resembling  yellow  fever,  7 
died.  A  full  epidemiological  account  of  the  disease,  gathered  from  the 
municipal  archives  of  Torre  Annunziata,  has  been  prepared  for  the 
present  writing.  This  interesting  epidemic  outbreak  was  completely 
lost  sight  of,  and  for  the  time  apparently  forgotten  in  the  overshadow- 
ing gloom  of  the  terrible  cholera  epidemic  1884,  at  Naples,  on  the  eve 
of  which  it  occurred. 

The  history  of  yellow  fever  in  Europe  closes  in  1894,  with  the  death 
from  that  disease  of  two  seamen  in  a  hospital  at  Trieste.  The  contagion 
was  brought  to  Austria  from  Brazil  by  two  sailors  who  landed  from  a 
pest  ship  at  Genoa  and  went  by  land  to  Trieste. 

In  the  examination  of  literature  for  the  preparation  of  this  account, 
it  was  found  that  the  epidemiology  of  yellow  fever  is  not  anywhere 
collected  in  a  single  writing.  It  is  scattered  through  many  books.  A 
comprehensive  survey  of  the  subject  is  of  more  than  antiquarian  interest. 
It  has  at  least  the  value  of  teaching  that  the  disease  is  capable  of 
extending,  under  suitable  conditions,  and  prevailing  epidemically  in 
Europe,  as  it  did  in  Philadelphia  and  other  Northern  cities  of  the 
United  States,  a  century  ago. 

With  a  view  to  presenting  in  a  summary  manner  the  epidemiology  of 
yellow  fever  in  Europe,  this  account  has  been  prepared  from  the  exten- 
sive and  scattered  literature  of  the  subject. 


YELLOW  FEVER  INSTITUTE, 

Treasury  Department,  U.  S.  Marine-Hospital  Service, 
WALTER  WIMAX,  Surgeon-General. 

Bulletin  No.  4. 


Section  A — HISTORY  AND  STATISTICS  Sarg.  GEORGE  T.  VAUGHAN,  Chairman  of  Section. 


YELLOW  PEVER  Iff  PORTUGAL. 

By  J.  M.  Eager,  Passed  Assistant  Surgeon,  31.  H.  S. 
MARCH,  1902. 


YELLOW  FEYEB,  IN  PORTUGAL. 

1723.  In  the  year  1723,  yellow  fever  was  imported  into  Lisbon  from 
Brazil  and,  according  to  documents  in  possession  of  the  sanitary  council 
of  the  Kingdom  of  Portugal,  this  was  the  first  appearance  of  yellow 
fever  in  Europe.  At  that  time  Lisbon  had  a  population  much  smaller 
than  at  the  period  of  the  great  epidemic  of  1857.  Still  the  number  of 
persons  said  to  have  been  taken  ill  with  the  disease  and  the  mortality 
during  the  first  epidemic  were  greater  than  in  the  latter.  There  is, 
however,  no  accessible  document  giving  specific  information  on  the 
subject. 

1850.  At  Oporto,  in  July,  1850,  the  ship  Edward  I V  arrived  from 
Brazilian  ports  infected  with  yellow  fever.  Some  of  the  custom-house 
officers,  sent  on  board  in  the  discharge  of  their  duties,  were  attacked 
with  the  disease,  and  of  5  stricken,  3  died.  The  sanitary  authorities, 
with  a  view  to  averting  a  panic,  tried  to  prevent  the  truth  being  known, 
and  for  a  time  succeeded  in  concealing  the  facts.  Fortunately  the 
malady  did  not  spread  widely.  The  disease  was  confined  to  the  locali- 
ties in  which  the  custom-house  employees  lived. 

1851.  In  the  year  1851,  there  arrived  at  Oporto,  the  ship  Tentadora, 
coming  from  Eio  de  Janiero.  During  the  voyage,  5  of  the  crew  had  been 
attacked  with  yellow  fever.  Several  of  the  custom-house  employees 
who  went  aboard  the  ship  at  Oporto  were  taken  sick  and  died  of  yel- 
low fever.    The  ship  Edward  IV,  which  during  the  previous  year  had 


Section  A. 


10 


brought  yellow  fever  to  Oporto,  again  arrived  at  that  poit,  September 
10,  having  had  deaths  aboard  from  yellow  fever  during  the  voyage.  The 
vessel  spent  twelve  days  in  quarantine.  After  being  given  pratique, 
2  custom-house  men  posted  aboard  to  guard  the  ship  were  attacked 
with  the  disease  and  promptly  died.  A  little  later,  3  laborers  employed 
in  removing  the  cargo  from  the  hold,  and  several  other  persons  who 
had  been  on  the  vessel,  were  taken  ill  with  the  same  malady.  The 
disease  afterwards  spread  in  the  quarters  known  as  Miragaia  and  Mas- 
sarellos  aud  altogether  17  persons  died  in  consequence.  At  this  point, 
there  arrived  from  Brazil  another  vessel,  the  Santa  Cruz.  The  same 
malady  was  repeated  among  the  custom-house  employees,  the  steve- 
dores, and  other  persons  who  in  one  way  or  another  had  had  direct  rela- 
tion with  the  infected  ship.  The  popular  alarm  occasioned  by  these 
frequent  appearances  of  fatal  cases  resulted  in  the  appointment  of  a 
sanitary  commission  for  the  study  of  the  matter  and  the  recommenda- 
tion of  measures  of  betterment.  Notwithstanding  the  vigorous  means 
adopted  to  this  end,  cases  continued  to  occur.  The  infection  spread  to 
2  British  vessels  anchored  down  the  wind  from  the  pest  ship  Santa 
Crvz.  The  British  vessels  were  supposed  to  be  quite  isolated  from  the 
Santa  Crvz.  Soon  other  cases  appeared  on  2  Portuguese  vessels 
anchored  to  leeward  of  the  British  vessels.  Several  of  the  men  of  the 
Portuguese  vessels  died.  The  epidemic  lasted  a  short  time  only,  but 
there  were  40  deaths. 

1856.  The  third  epidemic  occurred  in  1856.  Early  in  July  some 
vessels  arrived  from  Brazil,  where  yellow  fever  prevailed.  July  12 
the  first  cases  appeared,  and,  as  before,  the  first  persons  affected  were 
custom-house  employees,  stevedores,  and  those  in  contact  with  the  sus- 
picious vessels.  Again  a  focus  of  infection  was  established  in  the 
Miragaia  quarter.  There  were  also  cases  of  yellow  fever  among  the 
soldiers  of  the  municipal  garrison,  but  a  marked  difference  was  noted, 
both  in  the  intensity  of  the  symptoms  and  in  the  issue  of  the  disease 
between  the  cases  falling  ill  on  board  ship  and  those  resulting  from 
contact  with  infected  persons  and  things.  The  first  cases  were  congre 
gated  in  a  special  hospital,  and  of  these,  16  out  of  21  died.  On  the 
other  hand,  only  10  deaths  took  place  among  the  27  soldiers  attacked. 
Energetic  measures  were  taken  by  the  authorities  of  the  port.  The  pest- 
ridden  vessels  were  isolated  and  carefully  disinfected.  Certain  of  the 
vessels,  being  evidently  deemed  infected  beyond  hope  of  cleansing,  were 
sunk  at  sea.  This  epidemic  began  July  21  and  ended  October  2,  1856. 
A  total  of  120  cases  and  63  deaths  resulted  from  the  outbreak. 

Belem  is  a  small  town  not  far  from  Lisbon.  It  was  the  seat  of  the 
lazaretto  during  the  epidemic  at  Oporto.  An  extension  of  the  epidemic 
began  by  the  death  from  yellow  fever  of  the  wife  of  a  pharmacist  at 
Belem.  This  case  was  followed  by  others  at  considerable  intervals,  and 
finally  an  epidemic  established  itself.  The  disease  was  mistaken  for 
typhus  fever  by  the  local  physicians,  but  the  members  of  the  royal 


11 


Section  A. 


commission  that  investigated  the  pestilence  found  that  at  least  some  of 
the  cases  presented  the  undoubted  characteristics  of  yellow  fever.  There 
was  an  epidemic  of  Asiatic  cholera  at  Lisbon  in  1855,  and  the  disease 
had  not  entirely  disappeared  in  1856,  though  it  had  diminished  and  was 
already  decreasing.  At  about  the  time  of  the  disappearance  of  the 
cholera,  some  cases  of  fever  appeared  in  Lisbon  having  the  same  symp- 
toms and  epidemic  characteristics  of  the  yellow  fever  at  Belem. 

1S57.  In  the  year  1857,  Lisbon  had  a  population  of  200,000  inhab- 
itants. Preceding  the  period  of  the  yellow-fever  outbreak  of  1857  the 
public  health  had  been  excellent.  The  mortality  rate  was  less  than  for 
the  corresponding  period  of  the  previous  year.  A  commission  dele- 
gated to  make  a  report  of  the  epidemic  could  not  determine  to  a  cer- 
tainty whether  the  disease  was  imported  by  sea  or  came  from  the  infec- 
tion of  former  epidemics  in  Portugal.  In  March,  the  steamship  Tamar 
had  lost  2  men  from  yellow  fever  on  a  voyage  from  Brazil  to  Portugal. 
The  steamship  only  touched  at  Portuguese  ports,  leaving  immediately 
for  England.  It  appears  that  it  was  this  steamer  that  carried  yellow 
fever  to  Southampton,  a  circumstance  that  will  be  referred  to  under 
another  head.  The  vessel  returned  to  Lisbon  in  the  month  of  Septem- 
ber. Early  in  July,  a  steamer  called  the  Genova  arrived  at  Lisbon, 
bringing  immigrants  from  Brazil.  Many  of  these  persons  were  so  ill 
that  all  of  them  were  sent  at  once  to  Belem  to  pass  the  period  of  quar- 
antine in  a  lazaretto.  In  the  beginning  of  July,  a  seaman  from  the 
Algarve  fell  ill  in  the  house  where  he  lodged,  aud  shortly  after  9  persons 
sickened  of  the  same  disease  in  the  same  house.  The  commission 
reported  that  it  was  impossible  to  state  what  was  the  outcome  of  the 
disease  in  these  10  cases,  from  which  it  may  be  inferred  that  they  were 
spirited  away  in  the  interest  of  their  neighbors.  At  Lisbon,  immigrant 
baggage  and  effects  were  stored  in  dirty  and  badly  ventilated  places. 
They  contained  trunks  with  the  miscellaneous  effects  and  soiled  clothes 
of  immigrants,  packages  of  rags,  and  sundry  articles,  many  of  them 
evidently  filthy  from  human  vomit,  sputum,  and  feces.  July  22,  a 
person  employed  at  the  baggage  division  of  the  customs  service  was 
taken  ill  and  died  in  five  days  with  the  symptoms  of  yellow  fever.  July 
29.  a  woman  who  had  been  in  frequent  contact  with  the  customs 
employees  fell  sick  and  was  dead  in  five  days.  From  this  moment, 
cases  began  to  multiply  in  the  localities  where  the  first  cases  were 
treated.  Neighboring  habitations  were  in  turn  invaded,  and  finally 
whole  streets  and  quarters  of  the  town  became  filled  with  cases.  Ulti- 
mately, distant  foci  developed,  originating  evidently  from  persons  in 
contact  with  yellow-fever  patients. 

While  in  the  city  the  epidemic  was  assuming  gigantic  proportions, 
the  health  of  the  harbor  remained  perfectly  good.  No  suspicious  cases 
were  reported  on  board  of  vessels  anchored  in  the  harbor,  nor  among 
the  public  servants  stationed  on  or  near  the  water,  to  guard  the  port 
and  shipping.    From  these  facts,  the  royal  commission  concluded  that 


Section  A. 


12 


the  infection  had  been  introduced,  not  by  the  vessels  or  their  personnel, 
but  by  filthy  fomites  deposited  in  the  customs  magazines  of  the  ports. 

During  this  epidemic,  13,757  persons  were  ill  with  the  disease,  and 
5,652  died.  Of  the  5,915  cases  treated  in  hospital,  1,932  died.  Of  the 
7,482  treated  at  their  homes,  3,466  died.  The  other  deaths  evi- 
dently occurred  among  vagabonbs  and  those  who  succumbed  in  public 
places  not  under  medical  control.  The  relative  proportion  of  the  cases 
to  the  inhabitants  was  1  to  35.4  ;  the  proportion  of  cases  of  yellow  fever 
to  other  diseases  was  1  to  3.18.  Of  the  3,466  who  died  at  their  homes, 
2,061  were  males  and  1,405  females.  The  mortality  was  much  greater 
in  proportion  to  the  number  affected  among  adults  than  among  children. 
Most  of  the  old  persons  who  were  stricken  died.  The  commission  noted 
that  occupation  had  no  influence  in  imparting  the  disease  except  in  so 
far  as  it  involved  exposure  in  the  open  air  during  the  night.  The  fas- 
tigium  of  the  epidemic  was  reached  during  the  month  of  October.  At 
the  beginning  of  the  epidemic,  the  disease  in  individual  cases  ran  its 
course  in  from  fifteen  hours  to  five  days.  Later  in  the  epidemic  the 
disease  lasted  longer  in  the  fatal  cases  as  well  as  in  those  that  ended  in 
recoveiy.  In  the  hospitals,  the  greater  number  died  during  the  first 
three  days  of  the  disease,  and  as  the  disease  progressed  there  was  a  con- 
stantly diminishing  mortality.  The  accessible  hospital  records  give 
the  following  showing : 


A  few  only  remained  in  the  hospital  for  a  month  or  more.  Of  persons 
employed  about  the  hospitals,  one- sixth  were  taken  sick  with  the 
disease  and  among  these  there  was  a  mortality  of  25  per  cent.  It  was 
especially  remarked  that  at  the  gas  works,  where  illuminating  gas  was 
produced,  not  a  single  case  of  yellow  fever  occurred  among  the  em- 
ployees, although  the  trade  exposed  the  workers  to  the  night  air.  In 
this  connection  it  is  interesting  to  consider  whether  it  might  not  be  that 
illuminating  gas  or  other  products  evolved  in  its  manufacture  served 
to  kill  mosquitoes,  spoil  their  appetite  for  human  blood,  or  at  least 
keep  them  at  a  distance. 

During  the  epidemic  at  Lisbon  there  were  112  cases  of  yellow  fever 
in  the  neighboring  city  of  Olivaes,  which  at  the  time  had  23,000  inhab- 
itants. Sixty  of  the  sick  persons  were  fugitives  from  Lisbon.  In  other 
neighboring  places  scattered  cases  developed.  It  was  remarked  that 
the  quality  and  direction  of  the  wind  had  no  perceptible  influence  in 
the  propagation  of  the  disease.  The  epidemic  commenced  July  22  and 
was  declared  finished  December  10,  1857. 


Discharged  seven  days  after  admission. . 
Discharged  eleven  days  after  admission 
Discharged  fifteen  days  after  admission. 


Discharged  three  days  after  admission 
Discharged  five  days  after  admission.. 


344 
357 
762 
788 
345 


13 


Section  A. 


1858.  During  the  months  of  January,  February,  and  March,  1858, 
cases  of  yellow  fever  were  reported  at  intervals  in  Lisbon.  In  conse- 
quence, a  total  of  11  deaths  were  attributed  to  the  disease. 

1858.  At  Vigo,  Fereol,  Oporto,  and  at  Ponta  Delgada,  in  the  Azores, 
cases  of  yellow  fever  were  imported  by  vessels  arriving  from  Brazil, 
in  1858.  The  sick  persons  were  promptly  isolated  and  the  disease  did 
not  spread. 


YELLOW  FEVER  INSTITUTE, 

Treasury  Department,  U,  S.  Marine-Hospital  Service, 
WALTER  WYMAN,  Surgeon-General. 

Bulletin  No.  5. 


Section  A. — HISTORY  AM)  STATISTICS.  Sun;.  GEORGE  T.  VAUGHAN,  Chairman  of  Section. 


YELLOW  FEVEK  IN  SPAIN. 

By  J.  M.  Eagee,  Passed  Assistant  Surgeon,  M.  H.  S. 


MARCH,  190k>. 


YELLOW  FEVER  IN  SPAIN. 

In  connection  with  the  first  appearance  of  yellow  fever  in  Spain,  the 
interesting  question  arises  of  the  initial  occurrence  of  yellow  fever  in 
Europe.  According  to  Moreau  de  Jonnes,  the  primary  importation  into 
Spain  was  in  1705.  If  this  were  true,  Spain  could  claim  to  be  the  first 
European  country  afflicted  with  the  disease,  for  the  story  of  the  alleged 
outbreak  at  La  Eochelle,  France,  in  1700,  lacks  scientific  authority. 
Villalba,  the  famous  Spanish  epidemiologist,  maintains,  however,  that 
the  original  introduction  into  Spain  took  place  in  1730.  In  this  opinion 
all  the  writers  of  importance  who  have  succeeded  Villalba  thoroughly 
concur.  So  that,  in  the  light  of  all  available  evidence,  it  must  be  con- 
sidered that  the  initial  advent  of  yellow  fever  in  Europe  was  at  Lisbon, 
Portugal,  in  1723. 

1730.  In  the  year  1730  a  ship  from  the  Americas  brought  to  Cadiz 
a  malady  never  before  seen  in  that  city.  The  disease  was  characterized 
by  a  malignant  fever,  a  yellow  discoloration  of  the  skin,  and,  in  the 
last  stages  of  fatal  cases,  by  black  vomit.  Many  pelsons  were  stricken 
with  the  malady,  and  the  epidemic  diffused  itself  through  other  cities 
of  Spain. 

1733.  At  Cadiz  the  disease  was  again  imported  in  1733,  but  the 
prevalence  was  not  extensive. 

1741.  A  vessel  from  the  Antilles  landed  a  large  cargo  of  merchandise 
at  Malaga.    Immediately  afterwards  a  pestilential  malady  was  evolved, 

15 


Section  A. 


16 


a  disease  exhibiting  the  same  aspects  as  the  fever  at  Cadiz  in  1730,  and 
of  such  mortal  violence  that  10,000  persons  died  from  the  scourge. 

1744.  Cadiz  was  again  afflicted  with  a  visitation  of  yellow  fever, 
brought  into  the  country  by  vessels  from  the  Antilles.  The  extension 
of  the  disease  was  of  moderate  intensity.  The  epidemic  spread  to 
Majorca,  in  the  Balearic  Isles. 

1746.  At  Cadiz  a  vessel  from  Cuba  again  introduced  yellow  fever. 

1749.  Another  importation  took  place  at  Majorca,  but  the  effects 
were  not  of  much  importance. 

1753.  The  squadron  of  Admiral  Don  Pedro  de  la  Cerda  brought 
yellow  fever  to  Cadiz.  The  infection  originated  in  America  and  was 
taken  to  Cartagena  by  the  same  ships  of  war.  Happily  there  was  not 
an  extensive  spread. 

1800.  The  disastrous  epidemic  of  this  year  commenced  at  Cadiz 
toward  the  latter  days  of  July.  Its  first  appearance  was  in  the  quarter 
known  as  Santa  Maria  and,  by  August  4,  had  counted  many  persons 
among  its  victims.  The  infection  spread  furiously  in  the  quarters  of 
Ave  Maria  and  San  Antonio.  Day  by  day  from  August  on,  the  pesti- 
lence extended,  propagating  itself  through  all  the  neighboring  sections 
of  the  city.  The  origin  of  the  contagion  was  attributed  to  three  sources. 
Suspicion  fell  first  on  the  American  corvette  Dolphin,  which  left  Havana, 
May  27,  1800,  for  Charleston,  where  she  arrived  four  days  later.  From 
Charleston,  the  vessel  sailed,  June  11,  for  Cadiz,  at  which  port  she 
arrived  July  6,  3  of  the  crew  having  died  of  yellow  fever  on  the  voyage. 
Twenty  days  after  the  last  death  and  on  the  completion  of  ten  days  of 
rigid  isolation,  the  health  of  all  aboard  being  perfect,  it  was  decided  to 
give  the  corvette  free  pratique.  The  second  possible  origin  of  the  dis- 
ease was  the  corvette  Aigle,  which  sailed  from  Havana,  May  22,  1800, 
and  on  the  passage  to  San  Lucar  de  Borameda  lost  5  hands  from  yellow 
fever.  At  San  Lucar  de  Borameda,  the  crew  dispersed  and  other  men 
were  shipped.  The  Aigle  arrived  at  Cadiz  June  30,  six  days  after  the 
arrival  of  the  Dolphin.  A  third  suspicious  source  was  the  ship  Jupiter, 
cleared  from  Vera  Cruz,  February  4,  and  arrived  at  Cadiz,  March  28. 
A  few  days  after  her  departure  from  Vera  Cruz,  1  of  the  officers  fell 
ill  and  died  in  five  days.  Then,  one  after  another,  all  hands  aboard 
were  taken  sick.  The  condition  of  the  ship  was  at  one  time  so  desperate 
that  the  captain  was  undecided  whether  to  proceed  on  the  voyage 
or  return  to  Havana.  The  members  of  the  crew,  however,  made  a 
good  recovery  from  their  illness,  and  the  vessel  went  on  her  way.  In 
addition  to  the  3  vessels  that  fell  under  direct  suspicion,  it  is  noted 
that,  a  large  number  of  vessels  were  continually  entering  the  port  and 
that  by  an  order  of  the  King,  dated  February  1,  1800,  it  was  absolutely 
prohibited  to  submit  to  quarantine  any  vessel  coming  from  America. 
Thus  all  safeguards  were  for  the  time  removed. 

This  epidemic  was  extremely  desolating  and  mortal.  Cadiz  had  at 
the  time  a  population  of  57,499.    From  August  18  to  November  30,  the 


17 


Section  A, 


number  of  persons  who  had  fallen  ill  of  the  disease  was  48,520  and  of 
these  7,387  died.  At  the  latter  date,  there  were  357  cases  still  under 
treatment.  Of  those  who  died,  5,810  were  men  and  1,577  women.  So 
that  of  the  fatal  cases,  between  78  and  79  per  cent  were  males.  The 
maximum  mortality  among  males  occurred  between  the  ages  of  21  and 
40,  and  for  females  between  the  ages  of  1  and  10  years.  The  sickness 
diffused  itself  in  several  communities,  among  others  Puerto  Santa 
Maria,  Isla  de  Leon,  Puerto  Eeal,  Xeres  de  la  Frontera,  and  finally  it 
reached  Seville,  August  23. 

Seville  then  had  a  population  of  80,568  inhabitants,  of  whom  76,685 
were  attacked  by  the  malady,  and  14,685  died.  November  30,  at  the 
time  the  statistics  were  prepared,  85  cases  were  still  ill.  The  disease 
appeared  in  Seville  at  practically  the  same  time  as  at  Cadiz,  perhaps 
because  the  destination  of  the  passengers  of  the  corvette  Dolphin  was 
about  equally  divided  between  the  two  places.  It  should  be  remarked 
that  the  statistics  gathered  from  a  relation  of  the  facts  given  by  the 
celebrated  Dr.  Arejulas,  who  was  detailed  by  the  Spanish  Govern- 
ment to  investigate  the  disease,  differ  materially  from  those  contained 
in  a  report  sent  to  the  Danish  Government  by  Schousboe,  consul  of 
Denmark  on  duty  at  Cadiz.  The  two  writers  are  in  accord  concerning 
the  time  and  mode  of  introduction  of  the  sickness,  the  way  it  extended 
and  the  clinical  form  it  assumed,  but  differ  essentially  in  statistical 
figures. 

Arejulas'  estimates  are  given  in  the  following  table  : 


Cities. 

Popula- 
tion. 

Deaths. 

Cities. 

Popula- 
tion. 

Deaths. 

Cadiz  

6S.000 
32,  OIK) 
10,(X>0 
10,  0<>0 
25,000 

16,000 
6,000 
3,000 
(?)10,000 
6,000 

18,000 
6,000 
30,000 
80,000 

4,000 
1,500 
8,000 
30,000 

Isla  de  I^eon  

Therefore,  in  a  population  of  279,000  there  were  77,500  deaths.  The 
disease  also  invaded  Cartagena,  assuming  grave  features  and  making  a 
shocking  slaughter  among  the  inhabitants. 

1801.  Yellow  fever  broke  out  August  3,  1801,  in  Medina-Sidonia. 
The  first  person  attacked  died  in  six  days.  A  few  days  later  the  rela- 
tives of  the  dead  man  were  stricken,  then  the  malady  manifested  itself 
among  the  inhabitants  of  neighboring  houses,  and  finally  step  by  step 
the  epidemic  spread  itself  over  the  entire  city. 

1802.  After  the  doleful  visitation  of  1741,  yellow  fever  had  spared 
the  city  of  Malaga  at  times  when  it  worked  its  ravages  in  other  cities 
of  southern  Spain.  But  in  1802,  Malaga  suffered  a  small  epidemic  of 
brief  duration. 

1803.  The  slight  prevalence  of  the  previous  year  was  like  a  mild 
premonition  of  the  terrible  calamity  that  tormented  Malaga  in  1803. 
The  importation  was  blamed  upon  various  vessels.    A  Dutch  ship,  the 


Section  A. 


18 


Giovane  Nicola,  sailed  from  Smyrna,  March  14,  and  arrived  at  Malaga 
on  the  twenty-second  of  the  same  month.  Daring  the  voyage  she  Had 
been  obliged  by  contrary  weather  to  take  refuge  in  several  ports.  Sus- 
picion attached  to  her.  Two  French  ships  were  also  considered  ques- 
tionable from  a  sanitary  point  of  view.  They  were  the  Desaix  and 
V  Union,  carrying  soldiers  between  Marseille  and  Santo  Domingo  and 
had  had  deaths  of  a  doubtful  nature  aboard.  The  Spanish  ship  Provi- 
dencia  too  was  viewed  askance  by  the  sanitary  authorities.  She  arrived 
June  9,  from  Montevideo  with  dirty  documents,  tales  of  yellow  fever 
and,  notwithstanding  all  this,  had  been  submitted  to  only  a  brief  period 
of  detention.  This  much,  however,  is  certainly  known.  The  first  case 
of  yellow  fever  was  verified  in  the  person  of  Felix  Munoz,  a  smuggler, 
who  had  gone  on  board  the  Dutch  ship  and  returned  to  Malaga  with 
some  pairs  of  cotton  stockings  and  a  quantity  of  tobacco.  Shortly  after 
he  sickened  of  yellow  fever  and  died  in  five  or  six  days.  The  munici- 
pal sanitary  authorities  closed  the  house  of  the  dead  man  and  sent  to 
the  open  country  all  those  who  had  been  in  contact  with  the  patient  or 
who  had  stopped  in  the  neighboring  domiciles.  Thirty-six  days  passed 
without  any  case  manifesting  itself.  The  disquieting  apprehensions  of 
the  citizens  were  therefore  calmed  for  the  moment.  However,  one 
Christobal  Verduras,  living  in  the  Perchel  quarter,  had  during  this  time 
received  another  smuggler  in  his  house,  where  the  man  was  taken  ill 
and  died  promptly.  The  facts  were  for  the  time  concealed  and  the 
cadaver  transported  secretly  from  the  house  in  the  night  and  buried  in 
the  church  of  San  Pedro.  August  6,  the  son  of  Verduras  fell  sick,  and 
then  his  wife  and  then  3  other  sons.  In  short,  within  eight  days 
after  the  death  of  the  second  smuggler,  8  persons  of  Venduras' 
family  were  prostrated  in  the  same  manner.  Three  of  them  died. 
Afterwards  there  were  cases  in  the  habitations  surrounding  that  of 
Verduras.  At  the  same  time,  another  center  of  infection  was  estab- 
lished where  the  first  smuggler  was  buried.  The.  parish  priest,  the 
pallbearers,  the  sacristan  were  attacked,  and  likewise  the  physicians 
who  had  treated  the  patient.  All  of  them  died.  In  this  way  making 
gradual  advances,  the  whole  city  was  invaded  by  an  intensely  pernicious 
contagion.  The  epidemic  endured  until  December  18.  Of  the  48,015 
inhabitants  that  Malaga  numbered  at  the  beginning  of  the  outbreak, 
many  fled  from  the  city  and  carried  the  scourge  throughout  southern 
Spain.  The  noxious  character  of  the  disease  is  evident  from  the 
figures  which  show  that  of  those  who  remained  in  Malaga,  16,517  fell 
ill  and  9,333  died.  On  December  18  there  were  still  300  persons  con- 
valescent in  the  hospitals.  A  fact  worthy  of  remark  is  the  absolute 
immunity  of  the  large  prison  in  the  center  of  the  infection.  In  the 
beginning  of  the  pestilence,  the  commandant  of  the  prison  established 
rigorous  isolation  and  thus  seems  to  have  saved  those  detained  in  his 
custody.  In  the  same  year,  1803,  yellow  fever  spread  widely  in  the 
city  of  Cadiz  with  great  havoc  to  health  and  life. 


19 


Section  A. 


1804.  Being  unable  to  fix  upon  a  new  source  of  importation,  Spanish 
epidemiologists  concur  in  the  opinion  that  the  renewed  prevalence  in 
1804  was  a  recrudescence  of  the  scourge  of  the  preceding  year.  The 
second  attack  was  for  Malaga,  at  least,  more  disastrous  than  the  pri- 
mary invasion.  When  the  first  persons  were  affected  in  the  latter  part 
of  June,  a  wild  panic  ensued.  The  inhabitants  fled  in  swarms,  so  that 
on  July  1  only  the  poor  and  needy  remained.  It  appears,  however, 
from  the  chronicles  of  the  day  that  this  class  was  sufficiently  numerous 
to  furnish  ample  fuel  for  the  epidemic.  It  is  recorded  that,  before  the 
close  of  November,  there  had  been  at  Malaga  18,582  cases  of  yellow 
fever  and  7,726  deaths. 

Gibraltar,  owing  probably  to  the  severe  measures  insisted  upon  by 
the  local  government,  had  in  past  years  remained  free  from  yellow  fever. 
Presuming  upon  this  fortunate  immunity,  there  was  in  1804,  from  all 
accounts,  a  decided  relaxation  of  vigilance.  Through  the  rents  in  the 
cordon,  several  smugglers  from  Cadiz  or  Malaga  stole  into  Gibraltar. 
That  they  carried  something  more  harmful  to  public  interests  than  con- 
traband goods  is  obvious  from  the  sequel.  Some  of  them  developed 
yellow  fever  in  the  midst  of  the  healthy  population  of  Gibraltar  and 
died  diffusing  the  contagion  among  the  inhabitants.  The  epidemic  was 
very  deadly,  causing  a  mortality  of  4,000  souls. 

Cadiz  suffered  with  the  other  Spanish  cities  in  this  year  of  gloom. 
The  epidemic  disease,  imported  evidently  from  Malaga,  showed  a  most 
malignant  violence. 

Alicante  was  also  fiercely  tormented  with  yellow  fever. 

At  the  time  of  the  outbreak  at  Malaga,  a  tailor  named  Delgado,  who 
lived  in  a  house  in  the  Strada  Puerta  Nueva,  escaped  from  detention 
and  arrived  at  Antequara  July  23.  Four  days  later  he  was  prostrated 
with  yellow  fever  and  died  on  the  sixth  day.  His  father  and  mother,  3 
brothers  and  2  sisters  lived  in  the  same  house.  Of  these  7  persons,  5 
speedily  succumbed  to  the  disease.  The  contagion  then  spread  with 
incredible  swiftness  and  swept  down  before  it  such  a  number  of  people 
that  there  was  not  time  enough  to  bury  the  dead.  In  the  early  days  of 
October,  the  violence  was  so  mortal  that  between  30  and  37  persons 
died  every  day.  The  populace  with  religious  fervor,  hoped,  by  ren- 
dering thanks  to  God  for  the  preservation  of  the  living,  to  abate  the 
affliction.  A  procession  was  formed  with  lavish  sacramental  accom- 
paniments. The  ceremony  lasted  for  several  hours  and  was  partici- 
pated in  by  persons  of  all  classes.  The  hope  of  the  people  seemed, 
however,  to  be  vain.  An  augmentation  of  the  epidemic  immediately 
set  in  and  the  daily  register  of  deaths  ran  up  to  between  80  and  85. 
November  6  the  epidemic  was  declared  ended. 

An  interesting  incident  is  related  as  accounting  for  the  outbreak  of 
yellow  fever  at  La  Eambla,  the  same  year.  A  man  from  La  Eambla, 
moved  by  religious  ardor,  was  seized  with  a  desire  to  touch  the  litter  on 
which  the  body  of  a  man  dead  of  yellow  fever  was  being  borne  to  the 


Section  A. 


20 


grave.  Returning  to  his  native  place,  the  citizen  of  La  Rambla  began 
to  ail  from  a  slight  febrile  disorder,  but  was  well  in  a  few  days.  A 
cousin  who  had  waited  on  the  sick  man  died  of  yellow  fever  a  week 
after.  A  little  later,  several-  other  persons  who  had  been  in  contact 
with  the  fever  patient  fell  ill  also.  Thus  several  foci  of  contagion 
originated  at  La  Rambla,  where  the  disease  continued  its  destruction 
until  November  15. 

The  epidemic  at  Mantilla  in  1804  was  attributed  to  a  monk  from 
Malaga  who  was  taken  sick  at  Mantilla,  August  11,  and  died  in  five 
days.  The  houses  where  the  deaths  had  occurred  were  closed  and  all 
persons  having  contact  with  the  cases  were  isolated.  September  4, 
another  monk,  a  fugitive  from  Malaga,  was  attacked  with  yellow  fever 
and  in  a  few  days  died.  A  muleteer  returning  from  Malaga  fell  victim 
to  the  same  fate.  From  these  foci,  the  disease  extended  to  a  large 
portion  of  the  community,  but  owing,  it  appears,  to  the  energy  of  the 
sanitary  authorities  did  not  work  such  ruin  as  elsewhere.  November  29, 
the  city  was  declared  free  from  yellow  fever. 

The  city  of  Espejo  is  located  on  a  very  high  level.  There  arrived, 
August  27,  a  muleteer  carrying  merchandise  bought  at  Malaga.  The 
man  fell  sick  promptly  and  the  physicians  diagnosed  the  case  as  one  of 
yellow  fever.  The  patient  was  at  once  carried  into  the  open  country 
and  the  goods  he  had  brought  were  destroyed.  All  persons  who  had 
contact  with  the  muleteer  sickened  and  a  majority  succumbed.  The 
disease  extended  at  first  to  the  portion  of  the  city  frequented  by  the 
friends  of  the  muleteer.  A  rigorous  cordon  was  instituted  and  thus 
other  sections  were  spared.    The  disease  terminated  November  25. 

The  prevalent  disease  was  introduced  into  Vera  by  a  family  flying 
from  the  rage  of  the  epidemic  at  Cartagena.  Almost  all  the  members 
of  the  fugitive  family  were  stricken  and  died.  October  3,  an  assistant 
at  the  hospital  was  attacked  and  died  the  tenth  day.  From  that  time 
on,  the  malady  prevailed  in  the  infected  quarter,  ceasing  in  the  last 
days  of  November,  but  complete  isolation  saved  the  rest  of  the  city. 

Ronda,  another  Spanish  city  suffered  from  the  scourge  of  1804.  Two 
men  flying  from  Malaga  took  lodgings  at  Ronda,  in  the  house  of  a 
woman  of  easy  morals.  The  woman  died  August  4,  after  an  illness  of  a 
week's  duration.  August  12,  a  neighbor  was  taken  sick  and  died  in 
two  days  with  the  symptoms  of  yellow  fever.  All  the  houses  in  the 
neighborhood  were  then  quarantined.  This  wise  police  system  operated 
to  end  the  epidemic  by  the  end  of  October,  but  not  until  50  persons  had 
died  of  yellow  fever. 

So  far  it  has  been  seen  that,  after  nearly  half  a  century  of  immunity, 
Spain  suffered  5  annual  recurrences  of  yellow  fever  ending  in  the 
year  1804.  Then  followed  a  period  of  freedom  from  the  disease  lasting 
until  1808. 

1808.  In  this  year  an  importation  of  yellow  fever  took  place  at 
Cadiz,  but  the  developments  were  unimportant. 


21 


Section  A 


The  consequences  were  less  happy,  however,  at  Xeres  de  la  Frontera, 
in  which  city  an  individual  from  Cadiz  diffused  the  contagion.  Bigorous 
prophylactic  measures  were  taken  to  protect  the  large  prison  at  Xeres 
de  la  Frontera,  and  were  successful  until  near  the  decline  of  the  epi- 
demic. At  that  point  some  prisoners  slipped  away,  but  were  captured 
and  returned  to  the  prison.  They  brought  back  yellow  fever  with  them, 
and  so  terrible  was  its  effects  within  the  prison  walls  that  only  a  few  of 
the  convicts  escaped  death. 

1810.  In  August  of  this  year  an  epidemic  appeared  simultaneously 
in  Gibraltar,  Cadiz,  and  Seville.  It  was  impossible  to  determine  defi- 
nitely where  the  disease  began,  but  it  seemed  probable  that  it  was 
introduced  into  Cadiz  and  Seville  by  smugglers.  Its  maximum  preva- 
lence was  at  Gibraltar.  The  epidemic  was  also  transplanted  in  Carta- 
gena and  attained  considerable  violence. 

1811,  1812.  At  Cartagena,  the  disease  appeared  again  in  the  2  fol- 
lowing years  and,  inasmuch  as  no  new  source  of  importation  could  be 
discovered,  the  epidemics  of  1811  and  1812  were  considered  to  be  a 
reawakening  of  the  pestilence  of  1810. 

1813,  1814.  In  these  years  there  was  yellow  fever  at  Gibraltar,  the 
first  year  from  an  original  importation,  the  following  year  from  a  revival 
of  the  contagion  introduced  the  previous  summer. 

1819.  Spain  had  enjoyed  five  years'  exemption  from  yellow  fever  when 
a  period  of  deadly  pestilence  arrived.  Cadiz  was  doomed  to  suffer  one 
of  the  most  widespread  and  mortal  epidemics  that  ever  fell  to  her  fate. 
The  King  of  Spain  prepared  a  military  expedition  to  go  to  the  Americas 
and,  among  other  vessels,  hired  a  ship  named  San  Juliano,  recently 
returned  from  the  Philippine  Islands.  The  vessel  had  scarcely  begun 
to  take  her  cargo  of  cannon  powder  at  the  Isla  de  Leon  when  suspected 
cases  of  yellow  fever  appeared  among  the  persons  employed  aboard. 
The  disease  broke  out  also  in  the  quarter  of  the  city  called  Barrio  del 
Christo  where  the  baggage  of  the  crew  of  the  San  Juliano  was  deposited. 
The  persons  taken  sick  all  died  and  very  quickly  too.  This  occasioned 
great  alarm  in  Cadiz  and  the  commandant  of  the  city  sent  his  chief  sani- 
tary officer,  Dr.  Flores,  to  Isla  de  Leon  to  study  the  disease  and  report 
on  its  nature.  Dr.  Flores,  convinced  from  his  investigations  that  the 
disease  was  yellow  fever,  declared  that  rigorous  measures  alone  could 
avert  a  disaster.  But  his  counsels  were  not  listened  to.  On  the  con- 
trary, he  was  accused  of  high  treason  and  held  for  trial  before  a  tribunal 
of  war.  The  commanding  general  assured  the  alarmed  population  that 
yellow  fever  did  not  exist  on  the  Isla  de  Leon,  and  boastingly  added  the 
rather  unintelligible  information,  that  should  it  enter  the  city  of  Cadiz, 
he  was  prepared  to  meet  it  with  the  point  of  his  sword.  Notwithstand- 
ing all  assurances  to  the  contrary,  the  unheeded  warning  of  the  unfor- 
tunate Flores  came  true.  The  scourge  struck  with  frightful  force,  and 
among  the  first  to  run  away  from  the  city  was  the  redoubtable  general. 


Section  A. 


22 


From  July  to  December,  when  the  epidemic  ended,  there  were  40,000 
cases  and  8,000  deaths  in  Cadiz. 

A  woman  who  fled  from  Cadiz  took  refuge  in  Seville  and  died  there 
from  yellow  fever.  From  this  focus  the  disease  extended  throughout 
the  city,  manifestiDg  the  same  violence  and  malignancy  that  it  had 
shown  at  Cadiz. 

The  epidemic  also  entered  Xeres  de  la  Frontera,  where  it  was  highly 
mortal  in  its  effects. 

1821.  The  story  of  the  fatal  diffusion  of  yellow  fever  at  Barcelona  in 
1821  is  one  of  the  most  dismal  in  the  sanitary  history  of  Spain.  In  the 
port  were  anchored  many  vessels  of  all  nations,  among  them  the  Tailla 
Piedra  and  the  Gran  Turco,  recently  arrived  from  Havana.  A  great 
festival  was  arranged  for  July  12,  to  celebrate  the  anniversary  of  the 
promulgation  of  constitutional  law  in  Spain.  Bad  weather  prevented 
the  feast  being  celebrated  in  the  harbor,  and  the  festivities  were  there- 
fore postponed  until  July  15,  the  following  Sunday.  On  Sunday  the 
weather  was  splendid  and  a  large  concourse  of  people  congregated  to 
witness  the  fine  spectacle.  Captain  Sagredas,  commanding  the  Gran 
Turco,  gave  a  reception  on  board  his  ship.  His  wife,  their  children, 
and  many  other  persons,  altogether  40,  attended.  Later,  the  whole 
party  paid  a  visit  to  the  Tailla  Piedra.  After  spending  a  couple  of 
days  aboard  the  Gran  Turco,  the  captain's  family  went  to  Barcello. 
netta,  where  they  lived.  In  a  few  days  every  member  of  the  family 
sickened  of  a  strange  malady,  and  all  died.  A  like  fate  befell  most  of 
the  other  persons  who  visited  the  Tailla  Piedra.  Of  the  40  persons,  35 
died. 

Near  these  ships,  the  French  brig  Josephine  was  riding  at  anchor. 
The  crew  was  taken  with  yellow  fever  and  few  survived.  There  were 
suspicious  cases,  too,  on  board  a  war  ship  of  the  Kingdom  of  Naples. 
They  were  at  first  attributed  to  food  poisoning  from  using  for  culinary 
purposes  a  badly  tinned  copper  vessel.  The  captain  of  the  Josephine 
took  lodgings  ashore  at  Barcelona.  Eight  days  afterwards,  the  woman 
who  kept  the  inn,  where  he  stopped,  was  attacked  by  yellow  fever,  and 
in  rapid  succession  her  husband,  their  children,  and  the  servants  fell  ill. 
The  disease  reached  out  into  the  neighborhood,  extending  in  a  short  time 
to  the  whole  quarter,  and  later  overspread  the  city  of  Barcelona.  The 
municipal  authorities  adopted  proper  sanitary  measures  at  the  outset, 
but  they  met  with  great  opposition  from  the  people  who  objected  to 
interference  with  their  business  and  pleasure,  and  foolishly  refused  to 
regard  the  situation  seriously  until  the  epidemic  had  gained  the  upper 
hand.  The  maximum  intensity  of  the  prevalence  was  in  September. 
The  Eeport  of  the  National  Academy  of  Barcelona,  says : 

It  is  impossible  to  know  positively  the  number  of  victims  carried  off  by  the  epidemic 
that  covered  Catalonia  with  mourning,  nor  to  state  the  number  of  those  that  died  in  the 
neighboring  country  or  that  gave  up  their  lives  at  Mahon,  Tortosa,  and  Mequinenza. 

Francois  (in  his  report  to  the  French  Government),  Mazet,  Pariset, 
Bally,  and  Auduard  agree  in  estimating  that  approximately  in  the  city  of 


Section  A. 


Barcelona,  during  the  five  mouths  that  the  epidemic  raged,  25,000  persons 
died.    Of  the  population  of  150,000,  about  80,000  fled  from  the  city. 

The  same  year,  1821,  a  Danish  brig,  the  Initium,  sailed  from  Barce- 
lona and  in  six  days  reached  Malaga.  On  the  voyage  4  of  the  seamen 
were  sick  with  yellow  fever,  and  1  died  at  sea.  Arriving,  the  brig  was 
committed  to  the  lazaretto.  After  a  period  in  quarantine,  she  was 
given  free  pratique  and  took  two  additional  hands  aboard.  These  new 
men  promptly  sickened  of  yellow  fever,  and  both  of  them  died.  Sus- 
picious cases  appeared  on  some  English,  Danish,  and  Dutch  vessels  that 
were  anchored  alongside  the  Initium.  At  the  beginning,  the  sickness 
was  confined  to  the  vessels  in  the  harbor,  but  early  in  September  a 
master  calker,  who  had  been  working  on  one  of  the  ships,  carried  home 
with  him  some  effects  that  had  been  aboard.  September  7,  his  son  was 
taken  ill  and  died.  Then  he  himself  fell  sick,  but  recovered.  Other 
cases  broke  out  on  the  same  street ;  other  quarters  became  infected,  and 
so  the  disease  diffused  itself  over  the  city. 

The  city  of  Tortosa  had  never  suffered  from  an  invasion  of  yellow 
fever,  even  at  times  when  the  disease  was  most  widespread  in  Spain.  In 
the  night  of  August  5,  the  ship  Madona  de  la  Cinta,  coming  from  Barce- 
lona, entered  the  port  of  Tortosa  and  set  ashore  a  seaman  and  a  soap 
maker.  Both  of  them  died  shortly  of  yellow  fever.  The  seaman  died 
in  the  country  and  the  soap  maker  at  the  house  of  a  soap  manufacturer. 
The  latter  and  his  family  were  stricken  with  the  disease.  Then  the 
doctor  and  the  priest  fell  ill.  In  this  manner  the  disease  invaded  the 
city.  The  form  of  infection  from  all  reports  was  extremely  fatal,  for  it 
is  recorded  that  all  the  physicians,  pharmacists,  priests,  monks,  and 
nuns  in  the  city  died.*  After  a  month's  time  only  5,000  persons 
remained  in  Tortosa.  Ten  thousand  persons  fled,  and  at  the  end  of  the 
epidemic  4,500  of  the  5,000  that  remained  were  dead  of  yellow  fever. 

Alsco,  a  city  situated  on  an  elevated  site  about  30  kilometers  from 
Tortosa,  was  taken  with  yellow  fever  and  almost  decimated.  A  citizen 
of  Tortosa  while  in  Alsco  learned  that  his  wife  was  ill  in  Tortosa.  He 
borrowed  a  horse  from  a  friend  and  hastened  to  join  his  wife.  Both  man 
and  wife  died.  The  owner  of  the  horse  wanted  his  animal  back,  so  he 
sent  a  ser  vant  to  Tortosa  to  fetch  it.  The  servant  brought  back  the 
horse,  but  died  of  yellow  fever  and  infected  Alsco. 

Meguinenza  also  suffered  an  importation  of  the  pestilence  through 
the  medium  of  a  vessel  from  Tortosa  which  arrived  August  28.  A  sailor 
was  taken  ill  soon  after  disembarking  and  died  August  30.  Other 
] i) embers  of  the  family  died  in  a  few  days,  and  finally  the  malady 
affected  a  large  portion  of  the  community,  producing  disastrous  results 

Pal  ma,  the  capital  of  the  Balearic  Isles,  paid  tribute  also  to  yellow 
fever  in  1821.  A  vessel  bound  from  Barcelona  to  Majorca  carried  or 
board  a  merchant  of  Palma  as  a  passenger.  Arriving  home  the  mer 
chant  was  attacked  with  yellow  fever,  but  recovered.  Two  days  later, 
his  little  daughter  was  taken  ill  and  died.  From  this  focus,  the  disease 
3  YF 


Section  A. 


24 


was  disseminated,  attaining  the  proportions  of  a  great  epidemic  that 
destroyed  half  the  population  of  Palma. 

The  frightful  fierceness  of  the  epidemic  of  1821  in  Spain,  and  the 
havoc  produced  in  the  wealth  and  life  of  the  richest  industrial  section 
of  the  peninsula  by  frequently  repeated  and  devastating  pestilences, 
attracted  the  attention  of  other  nations.  There  were  accusations  of 
negligence  in  the  enforcement  of  sanitary  regulations.  This  led  the 
Government  of  Spain  to  adopt  precautions  for  the  prevention  of  future 
disasters.  The  leading  academies  and  societies  of  medicine  in  the  King- 
dom were  interpellated  as  to  whether  yellow  fever  could  be  considered 
absolutely  of  American  origin  and  of  an  infectious  and  contagious 
nature.  With  several  opinions  to  the  contrary,  the  majority  were  con- 
vinced of  the  exotic  origin  of  the  disease  and  that  it  was  infectious  and 
contagious.  As  a  consequence,  stringent  provisions  of  maratime  sani- 
tation were  devised  and  put  into  effect. 

•1823.  In  this  year  the  little  port  of  El  Passaje,  situated  on  the  north 
coast  of  Spain,  was  infected  with  yellow  fever  by  the  Spanish  brig 
Donastierra,  from  Havana.  The  authorities  sank  the  infected  ship. 
There  were  only  a  few  cases  ashore. 

1829.  Two  ships,  the  Dygden  aud  the  Neta,  arrived  at  Gibraltar,  hav- 
ing yellow  fever  aboard.  Linen  soiled  with  vomited  matter  was  sent, 
part  to  a  laundry  in  Gibraltar,  part  to  a  laundry  in  the  village  of 
Catalan  Bay.  The  washerwomen  contracted  yellow  fever  and  died. 
The  infection  was  circumscribed  and  not  very  violent. 

1870.  After  over  forty  years'  immunity,  Spain  again  found  yellow 
fever  within  her  borders.  Early  in  August,  1870,  the  ship  Maria 
arrived  at  Barcelona  from  Havana  having  yello  w  fever  aboard.  Through 
some  irregularity,  it  is  stated,  the  vessel  was  gfven  free  pratique  with- 
out being  required  to  undergo  the  necessary  sanitary  treatment.  The 
physician  of  the  port  and  the  secretary  of  the  sanitary  office  were  blamed 
for  the  importation.  They  were  both  taken  with  the  yellow  fever  and 
died.  Other  members  of  the  same  families  were  stricken  and  then  some 
persons  who  had  been  in  direct  contact  with  the  sick  and  with  their 
effects.  The  disease  spread  through  the  city.  During  the  months  of 
August  and  September  the  mortality  reached  its  maximum.  Toward 
the  midle  of  October  the  daily  mortality  varied  from  25  to  40. 

The  disease  extended  rapidly  to  Valencia,  Alicante,  and  Palma  and 
was  taken  by  refugees  to  Madrid.  There  were  only  a  few  cases  in  the 
capital. 

1878.  The  history  of  yellow  fever  iu  Spain  ends  with  an  epidemic  at 
Madrid  in  1878.  A  body  of  soldiers  from  Havana  was  disembarked  at 
Santander  and  transported  by  raif  to  the  capital  city.  They  had  scarcely 
arrived  in  barracks  when  yellow  fever  broke  out  attacking  50  soldiers, 
of  whom  30  died.  All  the  soldiers  who  fell  sick  had  come  with  the 
party  from  Havana.  The  disease  was  not  communicated  to  the  other 
persons  who  were  in  attendance  on  the  sick. 


YELLOW  FEVEE  INSTITUTE, 

Treasury  Department,  U.  S.  Marine-Hospital  Service, 
WALTER  WYMAN,  Surgeon-General. 

Bulletin  No.  6. 


Section  C— TRANSMISSION.  Surg.  J.  H.  WHITE,  Chairman  of  Section. 


A  NOTE  ON  MOSQUITOES  IN  BAGGAGE. 

By  S.  B.  Geubbs,  Assistant  Surgeon,  M.  H.  S. 
(Experimental  Investigation  in  Hygenic  Laboratory,  M.  H.  S.) 


MARCH,  1902. 


A  NOTE  ON  MOSQUITOES  IN  BAGGAGE. 

In  the  light  of  recent  well  known  work,  showing  that  the  infection  of 
yellow  fever  may  be  transmitted  by  certain  mosquitoes  biting  a  person 
suffering  from  that  disease,  and,  after  a  certain  lapse  of  time  stinging  a 
nonimmune  person,  and  on  account  of  the  modifications  in  the  methods 
of  preventing  the  spread  of  this  disease  proposed  on  account  of  this 
discovery,  enormous  sanitary  and  quarantine  interest  attaches  to  the 
question,  How  far  may  a  mosquito  be  carried  in  baggage? 

That  these  insects  may  be  harbored  for  weeks  in  vessels  and  railroad 
trains,  and  even  breed  in  enormous  quantities  in  the  water  tanks  of 
ships,  and  so  be  carried  almost  any  distance,  has  been  shown  in  many 
instances.  Howard  considers  the  railroad  one  of  the  principal  means 
of  spreading  this  pest,  and  instances  are  numerous  of  out-of-the-way 
villages  or  localities,  previously  free,  being  infested  with  mosquitoes 
after  getting  railroad  connections  (a). 

Interesting  instances  of  mosquitoes  being  carried  great  distances  at 
sea  were  reported  lateiy  in  the  public  health  reports.  Passed  Assistant 
Surgeon  Cumming  stated  that  the  Spanish  bark  Maria  Blanquer,  sixty-five 
days  from  Eio  de  Janeiro,  arrived  at  South  Atlantic  Quarantine  Station 
carrying  a  veritable  plague  of  mosquitoes,  most  all  of  which  were  the 


(a)  Howard.  *'  Notes  OQ  the  mosquitoes  of  the  United  States,"  and  one  instance  per- 
sonally known  to  the  writer. 

1 


Section  C. 


2 


Stegomyia  fasciata.  Even  admitting  the  captain's  statement  that  there 
were  none  aboard  before  the  twenty-second  day,  this  leaves  forty-three 
days  that  the  insects  were  transported  in  the  winged  form.  In  the 
water  tanks  of  this  vessel  great  quantities  of  larvse  were  found  showing 
that  the  mosquitoes  were  propogating  on  shipboard  as  prolifically  as 
they  do  on  laud.  If  a  vessel  can  carry  the  Stegomyia  fasciata  on  a  voy- 
age of  sixty-five  days  during  all  of  which  time  they  propagate  and 
multiply,  it  is  evident,  that  within  certain  climates,  they  could  so  con- 
tinue on  a  voyage  of  any  length,  thereby  bringing  these  pests  to  our 
ports  from  foreign  shores. 

Surgeon  Havard,  of  the  Army,  in  a  letter  to  the  Medical  Record  cites 
the  experience  of  Dr.  L.  S.  Harvey,  U.  S.  A.,  who  reported  that  he 
accidentally  carried  mosquitoes  in  his  chest  from  Baracoa,  Cuba  to 
Washington.  The  chest  was  closed  sixteen  or  seventeen  days,  and  yet 
the  mosquitoes  were  able  to  fly  away  and  escape  when  it  was  opened 
here.  In  commenting  on  this  interesting  observation  Colonel  Havard 
says: 

If,  while  a  trunk  is  being  packed,  and  left  open  for  that  purpose,  mosquitoes  alight  in 
it,  it  is  not  unlikely  that  they  may  become  caught  among  the  iolds  or  layers  of  cloth- 
ing and  I  doubt  very  much  wheth'er  the  usual  amount  of  pressure  put  upon  the  contents 
of  the  trunk  when  closing  it  will  destroy  those  which  have  found  reiuge  in  the  many 
spaces  existing  in  the  corners,  inside  the  trays,  or  between  garments. 

Assuming  it  to  be  perfectly  possible  for  mosquitoes  to  enter  a  trunk 
or  other  piece  of  baggage,  even  when  carefully  packed,  it  has  been  the 
aim  in  a  series  of  tests  to  see  how  long  the  insects  could  so  live.  The 
experiments  were  made  on  the  Culex  pungens,  whose  degree  of  compara- 
tive resistance  with  the  Stegomyia  fasciata  has  not  been  determined,  but 
it  is  reasonable  to  suppose  that  the  two  varieties  are  not  greatly  dissim- 
ilar in  this  regard.  We  have  especially  desired  to  determine  how  long 
mosquitoes  would  live  packed  in  different  places  in  trunks  more  or  less 
full  of  clothing  and  ordinary  travelers'  articles  and  under  various  con- 
ditions of  moisture  and  temperature  and  with  the  presence  of  aromatic 
substances  sometimes  present.  To  this  end  mosquitoes  were  packed  in 
trunks  in  different  ways,  and,  besides,  these  conditions  were  imitated 
by  wrapping  the  insects  in  towels,  as  then  they  could  be  placed  in  a 
temperature  of  37°  C.  (incubator),  of  25°  to  28°  C.  (ordinary  August 
heat),  of  19°  to  20°  C.  (cold  room),  and  of  10°  to  13°  C.  (ice  chest). 

In  general  it  was  found  that  this  mosquito  {Culex  pungens)  lives  but  a 
short  time  in  close  confinement  and  that  the  greatest  factor  in  prolong- 
ing its  life  is  moisture.  The  next  factor  of  importance  is  a  certain 
amount  of  cold,  the  most  favorable  temperature  appearing  to  be  about 
20°  C.  As  it  is  the  female  that  attacks  man  it  is  also  interesting  to  note 
that  she  regularly  survived  the  male  under  nearly  all  conditions,  as 
would  be  expected  by  natural  laws. 

Mosquitoes  left  exposed  in  a  pill  box,  one  side  of  which  was  covered 
with  gauze,  if  dry  and  unprotected,  usually  die  over  night ;  if  protected 


3 


Section  C. 


by  a  damp  cloth  they  may  live  twelve  days  provided  the  temperature 
does  not  exceed  20°  C.  If  loosely  packed  in  a  trunk  at  summer  tem- 
perature (23°  to  28°  C.)  among  clothes  that  are  very  slightly  damp, 
they  will  nearly  always  live  six  to  eight  days,  and  then  they  most  often 
come  to  grief  from  some  outside  influence,  such  as  getting  stuck  in 
moistened  glue  of  the  box,  or  by  being  entangled  in  the  growth  of  a 
mold.  If  dry,  but  protected  by  cloths  or  by  being  packed  among 
clothes  their  average  life  is  two  days. 

The  results  in  many  experiments  have  varied  considerably,  but  the 
following  may  be  cited  as  an  average  series  : 


Treatment. 

Result. 

In  large  dry  towel  37°  C. 
In  large  damp  towel  37°  C. 

In  large  dry  towel  27°  C. 
In  large  damp  towel  27°  C. 

In  large  dry  towel  20°  C. 
In  large  damp  towel  20°  C. 

In  large  dry  towel  11°  C. 
In  large  damp  towel  11°  C. 

Tightly  packed  in  clothing  of  trunk,  perfectly 

dry.    Temperature  23°  to  28° C. 
Same  as  above,  except  clothing  damp. 

Placed  under  loose  clothing  in  trunk,  dry,  23° 

to  28°  0. 
Same  except  clothing  damp. 

All  dead  first  day, 

Lived  until  fifth  day.    Probably  affected  by 

growth  of  mold. 
Died  between  the  first  and  second  day. 
Died  between  fifth  and  sixth  day,  at  which  time 

towel  dry. 
Died  between  third  and  fourth  day. 
Five  out  of  six  died  between  the  eighth  and 

ninth  day.    One  female  lived  twelve  days. 
Died  between  fourth  and  fifth  day. 
All  lived  until  eighth  day.    One  female  lived 

until  eleventh  day,  then  probably  crushed. 
Died  between  second  and  third  day, 

All  alive  on  seventh  day, found  crushed  from 

tight  packing  on  the  eighth  day. 
Died  between  third  and  fourth  day. 

Died  between  ninth  and  tenth  day. 

As  the  glue  in  the  paper  boxes  so  often  became  softened,  entangling 
the  mosquitoes,  tin  ointment  boxes  with  the  top  replaced  by  gauze  were 
tried,  but  the  water  of  condensation  proved  a  great  objection,  as  can  be 
seen. 

Treatment. 

Result. 

Wrapped  in  two  damp  towels,  kept  at  37°  C,  5 
mciles  and  6  females. 

Wrapped  in  two  damp  towels,  kept  at  20°  to  25° 

C,  11  females. 
Wrapped  in  two  damp  towels,  kept  at  20°  C,  10 

females. 

Wrapped  in  two  damp  towels,  kept  at  about  11° 
C,  4  males  and  5  females. 

Three  were  alive  on  third  day,  rest  being  in 
water  of  condensation  that  covered  the  tin. 
All  dead  fourth  day,  same  cause. 

Inspected  on  third  day.  All  drowned  in  water 
of  condensation. 

All  dead  between  eleventh  and  twelfth  day. 

All  dead  by  sixth  day  except  1  female  which 
remained  alive  and  apparently  strong  until 
between  the  twelfth  and  thirteenth  day. 

Mosquitoes  packed  in  ordinary  trunks  containing  moth  balls  (naph- 
thalin)  or  camphor,  as  they  are  used  to  keep  away  moths,  but  other- 
wise under  the  most  favorable  conditions  of  protection  and  moisture, 
always  died  in  from  twenty-four  to  forty-eight  hours.  The  presence  of 
tobacco,  however,  seems  to  have  little  effect. 

Fearing  lest  the  daily  inspection  of  the  boxes  once  packed  away 
might  tend  to  lengthen  the  insects'  live  by  the  renewal  of  the  air  about 
them,  one  series  was  made  packed  in  damp  cloths,  in  which  one  box 
was  inspected  each  day  or  two  and  not  again  packed.    Most  of  these 


Section  C. 


4 


were  ruined  by  the  growth  of  molds,  but  boxes  were  found  having  one 
or  more  alive  on  the  second,  fifth,  seventh,  and  eighth  days. 

By  the  word  damp  it  must  not  be  understood  that  a  factor  of  mois- 
ture was  introduced  greater  than  could  be  found  in  actual  packed 
clothing.  In  most  of  the  experiments  and  in  all  of  those  cited,  the  wet 
towel  or  piece  of  fabric  to  be  wrapped  about  the  box  was  wrung  out  by 
hand  as  much  as  possible  and  then  folded  in  a  dry  towel  and  the  wring- 
ing repeated.  This  would  leave  it  a  little  damper  than  freshly  ironed 
linen,  or  the  filthy  sweaty  clothing  so  often  found  by  those  engaged  in 
practical  disinfection. 

As  before  stated,  all  these  experiments  were  made  on  mosquitoes  con- 
fined in  circular  pill  boxes,  one  side  of  which  had  been  replaced  by 
gauze.  Their  arrangement  prevented  their  being  crushed  in  the  pack- 
ing and  manipulations,  but  also  introduced  two  features  that  would 
tend  to  shorten  their  lives,  viz,  first,  the  violence  done  in  getting  them 
into  a  small  box,  and,  second,  the  restraint  that  prevented  them  from 
themselves  seeking  the  conditions  best  favoring  their  survival.  This 
ability  of  the  mosquito  to  protect  itself  is  very  pronounced  and  has 
been  noticed  in  the  experiments  made  on  them  with  gaseous  disin- 
fectants. (Laboratory  Bulletin  No.  6.)  It  would  probably  play  a  role 
in  prolonging  its  life  under  natural  conditions. 

Disregarding  these  unnatural  conditions,  we  must  conclude  from  our 
observations  on  the  Gulex  pungens  that  mosquitoes  having  once  found 
their  way  into  trunks,  boxes,  bundles,  or  other  baggage  could  live  there 
at  least  five  days,  ample  time  to  carry  them  from  the  infected  ports  of 
Mexico  or  Cuba  to  any  of  our  Southern  ports.  It  is  true  the  vast 
majority  of  the  Stegomyia  fasciata  so  carried  would  probably  not  be 
infected,  but  even  these  could  by  their  propagation  render  infectible  a 
locality  previously  immune. 

Some  eminent  authorities,  speaking  from  a  practical  standpoint,  have 
opposed  this  view.  Reed,  of  the  United  States  Army  Commission,  in 
an  address  on  "The  Prevention  of  Yellow  Fever,"  read  at  the  twenty- 
ninth  annual  meeting  of  the  American  Public  Health  Association  at 
Buffalo,  said : 

The  fear  that  has  been  entertained  that  infected  insects  may  be  imported  in  boxes  or 
trunks  we  believe  to  be  absolutely  groundless,  and  this  for  the  simple  reason,  as  shown 
by  numerous  observations  made  by  us,  that  mosquitoes,  when  deprived  of  water,  die 
within  a  few  days  Even  if  allowed  to  fill  themselves  with  blood  immediately  before 
the  experiment  is  begun  and  then  deprived  of  water,  practically  all  are  dead  by  the 
expiration  of  the  fifth  or  commencement  of  the  sixth  day.  We  may  say  that  of  a  large 
number  of  insects  tried  in  this  way  only  1  female  has  survived  until  the  sixth  day, 
and  then  in  a  feeble  condition.  Males  and  females  which  have  been  living  on  sugar 
and  water,  or  fed  two  days  before  on  Hood,  il*  deprived  of  water  and  food,  begin  to  die 
after  twenty-four  hours,  and  all  are  dead  on  the  fourth  morning.  Free  access  to  water, 
therefore,  is  necessary  for  the  existence  of  this  mosquito. 

As  will  be  seen  the  above  view  is  in  accord  with  our  observation  that 
mosquitoes  kept  exposed  to  ordinary  conditions  or  in  dry  wrappings 


5 


Section  C. 


die  in  two  or  three  days.  However,  this  does  not  consider  the  factor  of 
moisture  except  as  water.  The  effect  that  a  very  slight  amount  of 
moisture  will  have  on  the  length  of  time  this  insect  will  live  is  really 
remarkable.  A  mosquito  that  has  entered  a  piece  of  baggage  would 
never  have  free  access  to  water,  but  it  could  often  find  the  small  amount 
of  moisture  necessary  for  its  existence,  and  it  could  besides  find  pro- 
tection from  atmospheric  conditions,  for,  as  we  have  remarked,  our 
confined  mosquitoes  live  longer  if  wrapped  even  in  a  perfectly  dry  cloth 
than  when  entirely  exposed. 

Surg.  H.  E.  Carter,  of  the  Marine-Hospital  Service,  whose  painstaking 
and  extensive  observations  are  well  known,  writes : 

For  the  twenty  years  preceding  1899  the  baggage  from  Vera  Cruz,  Havana,  and 
Santiago  de  Cuba,  on  vessels  arriving  at  New  York,  unless  with  yellow  fever  en  route, 
entered  without  disinfection.  The  amount  of  this  baggage  from  Havana  and  Vera  Cruz 
is  large,  and  it  is  not  possible  but  that  much  of  it  came  from  houses  infected  with  yellow 
fever  and  much  of  it  was  not  clean.  All  of  this  baggage  was  opened  at  the  custom-house 
at  New  York  and  handled  in  hotels  there  and  at  Saratoga,  and  no  yellow  fever  is  reported 
among  the  customs  inspectors  in  New  York,  or  at  the  hotels  during  this  time. 

The  baggage  going  from  the  same  ports  to  Spain  for  the  last  thirty  years  is  even  more 
to  be  considered.  Its  amount  has  been  enormous  ;  much  of  it  (from  the  class  of  people 
to  whom  it  belongs)  must  have  been  foul.  Some,  the  lesser  part,  it  is  true,  of  this 
traffic  goes  to  the  Mediterranean  ports  of  Spain — Valencia,  Malaga,  and  Barcelona,  etc. — 
which  at  times,  1870  and  before,  have  been  "infectible  places,"  yet,  I  think,  we  have 
had  no  yellow  fever  reported  in  the  Peninsula  since  the  epidemic  of  1870. 

Of  course,  negative  evidence  is  convincing  only  in  proportion  to  its  mass,  and  that  a 
piece  of  baggage  or  100  pieces  of  baggage  from  an  infected  place  did  not  convey  infection 
to  nonimmunes  exposed  to  it,  means  little,  yet  the  amount  of  this  baggage  is  so  large — 
I  can  not  estimate  it  at  less  than  that  of  300,000  persons  from  Havana  alone — that  we 
must  claim  that  a  very  large  number  of  pieces  of  baggage  from  infected  houses  have  been 
introduced  into  New  York  and  Spanish  towns,  that  numbers  of  susceptible  people  have 
thus  been  exposed  under  various  conditions,  but  have  not  contracted  yellow  fever. 

To  me  the  mass  of  this  evidence  is  sufficient  to  be  convincing,  and  I  count  it  proven 
that  baggage  from  Havana  and  Vera  Cruz  will  not  convey  yellow  fever  directly  to 
people  after  the  voyage  to  New  York  or  Spain,  thus  that  yellow  fever  is  not  conveyed 
by  mosquitoes  carried  in  such  baggage. 

Whether  this  time  element  is  necessary,  of  course,  is  not  determined  by  these  obser- 
vations, but  it  is  a  factor  in  them. 

Whether  the  rare  cases  of  yellow  fever  we  sometimes  see  contracted  from  infection 
aboard  ship  may  be  due  to  infected  mosquitoes  brought  aboard  in  the  hand  baggage  of 
pu—engers,  and  opened  soon  after  coming  aboard,  may  be  a  question.  The  sister  who 
developed  yellow  fever  aboard  the  Vir/ilancia,  en  route  from  New  York  to  Havana,  is  a 
case  in  point,  and  we  occasionally  see  members  of  the  crew  with  yellow  fever.  One 
occurred  in  Havana  harbor  on  a  Ward  liner  en  route  from  Vera  Cruz  to  New  York  in 
1900.    Other  explanations  of  these  cases  may,  of  course,  be  possible. 

It  is  equally  true  that  yellow  fever  has  frequently  been  conveyed  by  ships  on  which 
no  yellow  fever  exists,  and  not  unfrequently  by  vessels  on  which  we  can  get  no  history 
of  there  having  been  any  yellow  fever.  In  these  cases  there  are  doubtless  mosquitoes 
already  infected  in  the  hold  or  other  parts  of  the  vessel,  to  which  the  crew  have  not 
been  exposed  since  they  became  capable  of  transmitting  the  disease  ;  or  the  crew  may 
have  been  immune  to  the  disease. 


Section  C. 


6 


Thus  looking  fairly  at  both  sides  of  the  question  and  reviewing  the 
experiments  and  observations  that  have  been  presented,  it  would  seem 
that  it  is  entirely  possible  for  a  mosquito  to  enter  ordinary  baggage  and 
live  there  long  enough  to  be  carried  from  the  infected  ports  within  a 
few  days  sail  of  our  Southern  shores,  but  that  in  reality  they  are 
seldom  so  carried.  Further  observation  by  our  quarantine  officers  and 
others  alive  to  the  subject  is  needed  before  final  judgment  is  passed, 
and  the  object  of  this  note  is  to  stimulate  such  work  on  this  important 
subject. 


YELLOW  FEVER  INSTITUTE, 

Treasury  Department,  U.  S.  Marine-Hospital  Service, 
WALTER  WSMAN,  Surgeon-General. 

Bulletin  No.  7. 

Section  D. — QUARANTINE  AND  TREATMENT.  Snrg.  R.  M.  WOODWARD,  Chairman  of  Section. 


YELLOW  PEVER— ITS  OCCURRENCE  AND  QUARANTINE  MANAGEMENT 
AT  THE  PORT  OF  MARSEILLE,  PRANCE. 

From  Report  of  the  Consul-General  of  the  United  States  at  Marseille, 
France,  to  the  Department  of  State. 


MARCH,  1903. 


Consulate- General  of  the  United  States, 

Marseille,  France,  January  2,  1902. 
Sir  :  I  have  the  honor  to  inclose,  for  transmission  to  the  United  States 
Marine-Hospital  Service,  a  report  on  the  subject  of  yellow  fever  at 
Marseille,  as  instructed  by  the  Department's  circular  of  December  5, 
1901. 

I  am,  etc.,  Kobert  P.  Skinner, 

Consul-  General. 

Hon.  David  J.  Hill, 

Assistant  Secretary  of  State. 


YELLOW  FEVER  AT  MARSEILLE. 

Very  little  information  is  obtainable  at  Marseille  concerning  the  sub- 
jects mentioned  in  the  Department's  circular  of  December  5.  Thus  far, 
France  has  escaped  any  serious  epidemic  from  this  cause.  In  1821, 
Barcelona  passed  through  a  rather  severe  experience,  and  in  1857  Nantes 
was  similarly  afflicted,  although  but  7  deaths  were  reported  at  that  time. 
In  both  instances,  the  disease  was  imported.  The  city  of  Marseille, 
properly  speaking,  has  been  absolutely  exempt  from  cases  of  yellow 
fever,  although  on  the  quarantine  island  of  Frioul  it  is  not  entirely 
unknown.  The  attitude  of  the  Government  with  respect  to  this  malady 
is  fully  set  forth  in  article  61  of  the  quarantine  law. 

In  France,  from  November  I  to  February  20,  if  a  ship  arrives  from  a  port  contami- 
nated with  yellow  fever,  whether  said  ship  be  above  suspicion,  suspected,  or  infected, 
the  authorities  will  limit  themselves  to  a  medical  visit  among  all  the  passengers,  the 
disinfection  of  all  soiled  linen  and  similar  apparel,  and  bed  clothing,  and  other  suspected 
articles  contained  in  passengers'  baggage,  and  the  disinfection  of  the  ship  or  of  the  part 
4  Y  F  1 


Section  D. 


2 


of  the  ship  which  the  sanitary  authorities  may  judge  to  he  contaminated.  If  cases  of 
yellow  fever  are  found  on  hoard  said  ships,  they  will  he  immediately  removed  and 
isolated  until  their  cure  ;  the  other  passengers  and  the  crew  will  be  subjected  to  sur- 
veillance (as  ordered  by  article  57),  for  seven  days. 

The  happy  exemption  of  this  country  from  yellow  fever  causes  the 
authorities  to  feel  that  there  is  practically  no  danger  of  serious  epidemic 
from  this  source.  Dr.  Catelan,  the  chief  of  the  quarantine,  has  long 
since  been  convinced  of  the  danger  of  infection  from  mosquitoes,  and 
his  first  care,  so  he  tells  me,  upon  the  landing  of  cases  at  the  island  of 
Frioul,  is  to  arrange  mosquito  nettings  about  the  bed  of  the  patient  in 
such  manner  as  to  prevent  the  local  mosquitoes  from  spreading  the  germs. 
I  append  herewith  a  list  of  the  ships  arriving  with  cases  of  yellow  fever 
on  board  during  the  last  ten  years  and  other  statistical  information  in 
relation  thereto. 

While  the  French  Government  is  undisturbed  with  respect  to  the 
possibilities  of  yellow  fever  in  this  country,  the  ravages  wrought  by  the 
disease  in  Senegal  and  other  of  the  French  colonies  have  awakened  the 
medical  authorities  to  the  importance  of  the  subject,  and  a  commission 
of  scientific  men  has  recently  been  sent  out  from  Paris  on  a  mission  of 
investigation.  They  have  already  visited  Senegal,  and  are  supposed  to 
be  en  route  for  Brazil  at  this  time.  For  many  years  the  annual  epi- 
demics in  Senegal  were  supposed  to  arise  from  unpreventable  causes, 
and  true  yellow  fever  was  not  identified  as  such  until  comparatively 
recent  times.  The  ravages  are  so  severe  in  that  colony  that  upon  the 
outbreak  of  fever  immediate  efforts  are  made  to  deport  all  Europeans 
engaged  there  in  business  or  in  the  Government  offices.  This  radical 
action  necessarily  disturbs  business,  and  the  medical  authorities  are 
hopeful  of  finding  some  means  of  counteracting  the  plague. 

Robert  P.  Skinner, 

Consul-  General. 


List  of  ships  arrived  at  Frioul,  infected  with  yellow  fever,  from,  1891  to  1901. 


Date.       Name  of  ship. 

Nation- 
ality. 

Port  of  de- 
parture. 

Duration 
of  pas- 
sengers' 

isolation. 

Num- 
ber of 
passen- 
gers 
disem- 
barked. 

Cases  and 
deaths  during 
voyage. 

Number  in 
lazaret. 

Cases. 

Deaths. 

Cases. 

Deaths. 

May  17,1891 
Jan.  19,1892 
Apr.  14,1894 

Apr.  17,1898 
May    3, 1898 
May  11,1898 
Nov.  3,1899 

Aug.  18, 1900 

French... 
 do  

....  do  , 
 do  

Plata  

Days. 
10 
3 
4 

5 

665 
103 
336 

416 

0 
0 
2 

8 
2 
0 
1 

3 

5 
2 
1 

4 
1 

2 
1 

2 

5 
0 
0 

0 
0 
0 

1 

0 
6 

al 
0 
0 

0 
bO 
oO 
dO 

0 

Provence  

Bu  enos 
Ayres 
and  Rio 
Bahia. 

Brazil  

 do  

Aquitaine  .... 

French... 
do.... 

Buenos 

Ayres. 
Rufisque... 

3 
7 

5 

a  Four  cured. 

b  Passengers  remained  on  board, 
c  Left  port  same  day  for  Genoa. 

d  Women  entered  at  Frioul  hospital  on  eighth  day,  had  lost  2  children  during  voyage. 


c 


4 


) 


wo  % 


YELLOW  FEVER  INSTITUTE,  BULLETIN  No.  8. 
Treasury  Department,  XT.  S.  Marine-Hospital  Service. 
WALTER  WTMAN,  Surgeon- General. 


YELLOW  FEVER 


IN 


France,  Italy,  Great  Britain,  and  Austria 


AND 


BIBLIOGRAPHY  OF  YELLOW  FEVER  IN  EUROPE. 


MAY,   1  9  O  2  . 


WASHINGTON: 

GOVERNMENT  PRINTING  OFFICE. 

1902. 


YELLOW  FEVER  INSTITUTE,  BULLETIN  No.  8. 


Treasury  Department,  U.  S.  Marine-Hospital  Service. 
WALTER  WTMAN,  Surgeon- General, 


The  person  charging  this  material  is  re- 
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Latest  Date  stamped  below. 

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To  renew  call  Telephone  Center,  333-8400 

UNIVERSITY  OF   ILLINOIS   LIBRARY  AT  URBANA-CHAMPAIGN 


Austria 


BI 


JPE. 


L161— O-1096 


WASHINGTON: 

GOVERNMENT  PRINTING  OFFICE. 
1902. 


YELLOW  FEVER 

IN 

France,  Italy,  Great  Britain,  and  Austria 

AND 

BIBLIOGRAPHY  OF  YELLOW  FEVER  IN  EUROPE. 


j^LJk-^zr  D  1  q  o  2  . 


WASHINGTON: 

GOVERNMENT  PRINTING  OFFICE. 
1902. 


YELLOW  FEVER  INSTITUTE. 

Treasury  Department,  U.  S,  Marine-Hospital  Service, 
WALTER  WIMAN,  Surgeon-Geiieral. 

Bulletin  No.  8. 


Section  A. — HISTORY  AND  STATISTICS.  Snr*  GEORGE  T.  YAUGHAN,  Chairman  of  Section. 


YELLOW  FEVER  IN  FRANCE,  ITALY,  GREAT  BRITAIN,  AND  AUSTRIA, 
AND  BIBLIOGRAPHY  OP  YELLOW  FEVER  IN  EUROPE. 

By  J.  M.  Eager,  Passed  Assistant  Surgeon,  M.  H.  S. 


M.A.Y,  1902. 


YELLOW  FEVER  IN  FRANCE. 

In  a  history  by  Arcere  of  the  city  of  La  Rochelle,  published  in  1756 
(vol.  2,  chap.  4,  cited  by  Frank),  there  is  a  reference  to  an  importation 
of  yellow  fever  that  occurred  at  La  Rochelle  toward  the  middle  of  the 
year  1700.    The  report,  however,  lacks  proper  corroboration. 

1802.  In  the  autumn  of  1802,  there  arrived  in  the  roads  at  Brest  a 
squadron  of  5  vessels  of  the  line  commanded  by  Admiral  Villaret  de 
Joyeuse.  The  ships  had  come  from  Santo  Domingo.  Among  the  crews 
were  42  persons  in  the  active  stages  of  yellow  fever  and  many  convales- 
cents. The  sick  seamen  were  disembarked  at  the  lazaretto  of  Tiberon, 
where  32  died.  A  custom-house  official,  after  being  for  several  days  on 
duty  aboard  one  of  the  vessels,  the  Tourville,  was  taken  with  yellow 
fever.  He  died  at  his  home  ashore.  Fortunately,  some  of  the  medical 
practitioners  who  were  called  in  to  see  the  sick  man  had  been  in  the 
West  Indies.  Thus  the  case  was  recognized  as  one  of  yellow  fever. 
Strict  sanitary  measures  were  adopted  and,  probably  owing  to  these 
precautions  and  the  fact  that  the  season  was  advanced,  the  disease  did 
not  spread. 

The  American  ship  Columbia  arrived  at  Marseille  in  1802  with  yellow 
fever  aboard,  but  there  was  no  diffusion  ashore. 

25 


Section  A. 


26 


t  1S1.M.  In  this  year-  there  was  an  epidemic  of  yellow  fever  in  Spain. 
Several  vessels  that  had  had  yellow  lever  aboard  on  the  passage  from 
Barcelona  entered  the  port  of  Marseille.  All  were  remanded  to  the 
lazaretto.  A  carpenter  who  worked  at  the  lazaretto  died  in  a  hospital 
at  Marseille.  Another  case  occurred  in  a  hospital  at  Marseille  that  year 
in  the  person  of  a  sailor  who  had  come  from  Barcelona  by  land.  The 
disease  did  not  spread.  The  mayor  of  the  city,  with  a  view  to  averting 
an  epidemic,  sent  for  the  famous  professor  Palloni,  who  had  been  through 
the  yellow-fever  epidemic  at  Leghorn  in  1804,  and  whose  diagnosis  and 
advice  were  relied  and  acted  upon  at  Marseille  with  the  happy  results 
mentioned. 

1839.  The  corvette  Caravane  arrived  at  Brest  with  yellow  fever 
aboard.  During  the  voyage  116  members  of  the  crew  had  been  down 
with  yellow  fever  and  33  died.    No  cases  occurred  ashore. 

1861.  In  the  year  1861  there  occurred  at  Saint  Kazaire  the  only 
important  epidemic  of  yellow  fever  that  ever  broke  out  in  France.  In 
an  article  on  mosquitoes  and  yellow  fever,  published  in  Paris  last  year 
(1901),  De  Gouvea  concludes  that  the  epidemic  at  Saint  Nazaire,  so 
carefully  observed  and  recorded  by  Melier,  was  determined  by  mosqui- 
toes infected  at  Havana  and  transplanted  to  France  in  the  hold  of  a 
vessel. 

The  Anne- Marie,  a  ship  of  the  port  of  Xantes,  with  a  crew  of  16  souls, 
sailed  from  Havana  June  13.  The  vessel  carried  barrels  of  sugar, 
between  the  tiers  of  which  layers  of  sugar  cane  were  placed,  in  order  to 
properly  dress  the  cargo.  After  five  days1  navigation,  five  days  of 
broiling  calms  and  storms  followed  by  rains,  the  captain,  in  order  to 
rest  the  crew,  decided  to  drift  in  the  Strait  of  Florida  without  using 
sails.  Passing  out  of  the  strait,  the  winds  became  steady,  and  the  men 
went  to  work  with  a  will  to  make  sail,  showing  uo  trace  of  fatigue  or 
malady.  July  1,  namely,  eighteen  days  after  the  departure  from 
Havana,  2  seamen  fell  sick,  and  died  within  a  few  hours  of  each  other 
on  the  fifth  day  of  their  illness.  July  2,  another  sailor  was  taken  ill,  but 
it  is  recorded  that  "with  strong  doses  of  the  sulphate  of  quinine  and 
with  violent  purgatives,  he  was  cured  after  ten  days."  On  successive 
days,  6  other  persons  were  stricken,  including  the  captain.  All  were 
dosed  with  quinine  and  cathartics  and  recovered  more  or  less  promptly. 
Altogether,  among  the  16  persons  aboard,  there  were  9  cases  of  sickness 
and  2  deaths.  In  this  condition  the  ship  entered  the  port  of  Saint 
Nazaire,  twenty  days  after  the  last  death  and  ten  days  after  the  incep- 
tion of  the  final  case  of  suspicious  illness.  Since  no  case  of  sickness  had 
occurred  during  the  last  ten  days  and  all  were  well  on  board  at  the 
time  of  arrival,  the  vessel  was  punctually  given  pratique,  in  conformity 
with  the  French  sanitary  regulations. 

The  Anne-Marie  lay  near  the  shore,  not  far  from  the  railroad.  At 
her  side  were  2  other  vessels,  the  Chastang,  belongiug  at  Indred.  and 
the  Connoron,  of  the  imperial  navy.    The  latter  vessel  was  loading 


27 


Section  A. 


boilers  from  the  former.  The  crew  of  the  Anne- Marie  was  disbanded 
and  the  captain,  who  had  not  yet  recovered  robust  health  after  his 
recent  illness,  went  to  Paimboeuf  to  recuperate.  The  discharge  of  the 
cargo  was  entrusted  to  17  stevedores,  all  hale  and  hearty  men. 

From  July  25  to  July  29  the  Ghost ang  lay  near  the  Anne  Marie.  Some 
of  the  men  of  the  Ghostang  went  aboard  the  Anne-Marie  and  paid  a  visit 
of  a  quarter  of  an  hour's  duration.  July  29,  the  Ghostang,  with  a  crew 
of  5  men,  left  for  Indret,  a  place  25  miles  above  Saint  Nazaire.  They 
arrived  at  Indret  the  same  day.  A  mechanic  on  the  Ghostang  sickened 
August  1  and  died  in  four  days.  At  about  the  time  of  the  mechanic's 
death  3  men  of  the  crew  of  the  Ghostang  were  taken  with  the  same 
symptoms.  The  clinical  picture  was  that  of  yellow  fever.  The  news 
of  what  had  occurred  at  Indret  had  not  yet  reached  Saint  Nazaire 
wheu,  August  2,  the  first  officer  of  the  Anne  Marie,  a  robust  man,  aged 
28  years,  died  after  being  ill  of  yellow  fever  for  sixty  hours.  The  next 
day.  a  cooper,  who  had  spent  several  days  in  the  hold  of  the  Anne- 
Marie  engaged  in  repairing  sugar  barrels,  fell  sick  of  the  same  disease 
and  died  in  five  days.  August  4,  a  master  stonecutter,  who  worked  on 
the  harbor  front,  260  meters  from  where  the  infected  vessel  was  sta- 
tioned, acquired  the  disease,  and  after  six  days  died.  He  had  had  no 
communication  with  the  ship,  no  contact  with  the  men  or  merchandise 
of  the  vessel.  August  5,  5  stevedores  from  the  infected  ship  were 
attacked.  Three  died  in  about  four  days,  the  other  in  eight  days. 
August  7,  there  were  3  more  cases,  and  2  others  the  following  day.  A 
woman  who  sold  old  clothes,  sails,  and  cord  was  taken  sick  of  yellow 
fever  August  6.  She  had  received  in  her  house  2  seamen  of  the  Anne- 
Marie  and  had  bought  from  them  some  discarded  garments  and  odds 
and  ends  of  canvas  and  cordage.  The  next  day,  a  prostitute,  aged  55, 
who  had  intimate  relations  with  the  stevedores  of  the  pest  ship,  was 
prostrated  with  the  same  malady.  A  laborer,  engaged  in  handling  the 
cargo  of  the  Anne-Marie,  lived  with  a  cobbler  at  a  long  distance  from  the 
port.  The  cobbler,  who  sat  at  his  bench  from  morning  till  night  and 
never  moved  from  the  place  of  his  work,  was  stricken  with  yellow  fever 
and  died  in  a  few  hours.  His  guest,  the  laborer,  and  the  laborer's  wife 
both  took  the  disease,  but  got  well. 

The  Gormoran,  with  6  men  in  the  crew,  was  for  four  days  (July  31  to 
August  3)  near  the  Anne-Marie,  loading  boilers,  as  has  already  been 
mentioned,  from  the  Ghostang.  The  Gormoran  had  no  communication 
with  the  Anne-Marie,  and  it  is  explicitly  stated  that  she  was  exposed 
only  to  the  emanations  that  issued  from  the  ballast  of  the  infected  ves- 
sel during  the  discharge  of  cargo.  The  Gormoran  went  to  Lorient,  a 
place  near  Saint  Kazaire,  August  10.  Four  days  later,  2  of  her  crew 
showed  symptoms  of  yellow  fever  and  were  dead  in  forty-eight  hours. 
The  necropsy  confirmed  the  diagnosis.  Two  lighters  were  also  anchored 
near  the  Anne-Marie.  One,  the  Jean  Bart,  had  a  crew  of  2  men  ;  aboard 
the  other,  Fere  Eugraud,  were  2  men  and  a  woman.    A  man  of  the  crew 


Section  A. 


28 


of  1  of  the  lighters  had  been  on  the  Anne-Marie  for  a  few  minutes  only, 
but  some  of  the  lightermen  had  assisted  at  the  funerals  of  the  victims 
at  Indret.  All  the  5  persons  on  the  lighters  suffered  from  a  disorder 
which,  though  it  had  not  the  typical  characteristics  of  yellow  fever,  bore 
a  close  resemblance  to  the  milder  form  of  the  disease. 

Still  other  vessels  were  infected  from  the  Anne-Marie.  A  steamer 
that  ran  between  Saint  Nazaire  and  Lorieot,  known  as  No.  6,  was  for  two 
days  (July  28  and  July  30)  alongside  the  Anne-Marie  and  had  communi- 
cation with  the  stevedores.  No.  6  left  Saint  Nazaire  July  30.  During 
ing  the  trip  to  Lorient  1  of  the  stokers  fell  ill.  He  died  in  six  days. 
About  the  same  time  the  ship's  boy  took  the  same  disease,  but  recovered. 

A  three-master,  the  Dardanelles,  lay  side  by  side  with  the  Anne- Marie , 
August  2  and  August  3,  in  such  a  position  that  to  go  ashore  from  the 
first  it  was  necessary  to  cross  under  cover  of  the  second.  The  ship's 
boy  of  the  Dardanelles  suffered  a  typical  attack  of  yellow  fever,  but  did 
not  die. 

A  vessel  from  Marseille  had  been  anchored  in  the  harbor  of  Saint 
Nazaire  from  June  23.  In  order  to  prepare  for  her  departure  she  was 
put  alongside  the  Anne-Marie  exactly  in  the  position  previously  occu- 
pied by  the  Dardanelles.  This  vessel,  after  her  departure,  spent  two 
days  at  Belle  Isle.  She  then  went  to  sea  and  lost  her  second  officer  from 
yellow  fever.  The  officer  fell  sick  August  5  and  died  after  seven  days. 
Twelve  days  after  his  death  the  ship's  boy  presented  the  same  symptoms, 
including  black  vomit,  and  died  in  nine  days.  On  the  26th  the  appren- 
tice developed  the  disease,  but  recovered.  August  29  a  seaman  took  to 
his  bunk  with  the  malady  ;  September  11  the  captain  sickened.  During 
the  next  month  6  other  men  were  prostrated  by  the  disease.  One  of 
them  died  on  the  fifth  day  after  invasion,  the  others  recovered. 

Altogether,  the  Anne-Marie  infected  7  vessels,  on  which  there  were  40 
cases  of  yellow  fever  and  23  deaths. 

At  Montoir  a  doctor  named  Chaillon  was  taken  sick  with  yellow  fever 
and  died  in  four  days.  He  had  been  in  attendance  on  a  patient  who 
had  worked  as  stevedore  on  the  Anne  Marie. 

The  records  of  the  epidemic  at  Saint  Nazaire  show  that  all  the  infected 
ships  were  stationed  down  the  wind  from  the  Anne- Marie  The  fact  is 
established  by  the  data  of  the  meteorological  and  maritime  observer  at 
Lorient.  It  is  interesting  to  note  that  a  ship  of  the  imperial  navy,  the 
Chandertiagor,  and  a  passenger  transport,  the  Lorientais  No.  8,  posted 
near  the  Anne-Marie  but  up  the  wind,  were  perfectly  immune  from 
yellow  fever.  The  distance  of  anchorage  and  the  length  of  time  passed 
near  the  infected  vessel  seemed  to  have  had  decided  influence  in  deter- 
mining outbreaks  of  the  disease.  The  prevailing  temperature  did 
not  appear  to  have  any  influence.  The  daily  temperature  during  the 
epidemic  oscillated  between  the  maxima  of  21°  and  25.5°  C.  and  the 
minima  of  3.1.8°  and  17°  C. 

II.  (le(iouvea,  in  his  article  already  referred  to  on  mosquitoes  and 


29 


Section  A. 


yellow  fever,  published  October  12,  1901,  in  Le  Bulletin  Medical,  Paris, 
referring  to  the  epidemic  just  described,  says  : 

All  these  facts  adapt  themselves  in  a  perfect  fashion,  in  our  opinion,  to  the  theory  of 
the  propagation  of  yellow  fever  by  mosquitoes.  We  may  assume  at  the  outset  that, 
during  the  loading  of  the  vessel  at  Havana,  a  certain  number  of  mosquitoes,  previously 
infected  by  sucking  the  blood  of  yellow-fever  patients  living  in  the  near  neighborhood, 
could  enter  the  vessel's  hold  filled  with  cases  of  sugar  and  many  stalks  of  sugar  cane 
placed  as  a  filling  in  the  angular  spaces  of  stowage  to  hold  the  cases  in  place  and  pre- 
vent Iriction.  The  stalks  could  have  furnished  the  mosquitoes  with  necessary  nourish- 
ment during  the  voyage. 

During  the  broiling  calms  that  followed  five  days  alter  the  departure  of  the  vessel 
from  Havana,  the  mosquitoes,  excited  by  the  heat  of  the  atmosphere  and  of  the  hold, 
could  very  easily  pass  the  defective  bulkhead  that  separated  the  hold  from  the  lodg- 
ment of  a  certain  number  of  the  crew  and  installing  themselves  in  that  place  sting  the 
sailors  who.  as  we  have  seen,  were  at  the  time  enjoying  a  period  of  repose,  and  thus 
inoculate  them  with  the  germs  of  the  disease.  The  infection  of  the  stonecutter  who 
v  as  at  a  great  distance  ('-'60  meters)  from  the  vessel,  and  who  had  had  no  contact  with 
the  ship,  is  explained  in  the  preseut  state  of  our  knowledge  in  the  following  way  : 
The  infected  mosquitoes  escaping  from  the  hold  of  the  vessel  and  carried  by  the  wind 
that  blew  in  the  direction  of  the  workman,  fixed  themselves  upon  and  stung  him. 
The  infection  of  the  physician  of  Montoir,  Dr.  Chaillon,  is  explained  in  the  same 
manner  by  the  stings  that  he  had  received  during  his  prolonged  visit  to  the  patient 
whom  he  treated,  a  stevedore  of  the  Anue-JIarie,  suffering  from  yellow  fever  and  living 
in  a  room  on  the  ground  floor  in  a  marshy  region  where  paludal  fevers  prevailed. 

All  the  other  cases  of  infection  are  explained  very  simply  since  they  all  occurred  in 
individuals  who  had  been  for  a  longer  or  shorter  time  in  the  hold  of  the  vessel  or  in 
individuals  who,  like  the  sailors  of  the  other  vessels,  had  been  down  the  wind  from  the 
infected  ship.  With  all  the  cases  of  yellow  fever  that  occurred  at  Saint  Nazaire  and 
Montoir,  the  malady  was  not  propagated  by  any  of  the  effects  of  the  crew,  taken  with 
them  to  their  families  nor  by  the  ship's  cargo  sent  directly  to  Nantes  by  the  railroad. 

Following  the  epidemic  at  Saint  Nazaire  there  were  reports  of  the 
importation  of  yellow  fever  in  many  of  the  ports  of  France,  not  only 
Mediterranean,  bat  those  of  the  west  and  north  as  well.  There  was, 
however,  no  diffusion  of  the  disease. 

1862.  A  vessel  named  the  Harriet  arrived,  in  the  year  1862,  at  Havre 
with  yellow  fever  aboard.  The  cases  were  so  numerous  that  the  author- 
ities were  forced  to  open  the  lazaretto  at  Tatihon,  near  Cherbourg. 

1870.  At  the  time  of  the  epidemic  in  Spaiu,  a  vessel  named  the  Argos 
arrived  at  Marseille  from  Barcelona  with  yellow  fever  aboard.  The 
cases  were  all  cared  for  in  the  lazaretto,  except  1  seaman,  who  went  to 
Marseille  by  land,  was  attacked  by  yellow  fever,  and  died  in  the 
municipal  hospital.    Fortunately,  there  was  no  spread  of  the  disease. 

YELLOW  FEVER  IN  ITALY. 

The  history  of  the  two  epidemics  in  Italy  alleged  to  have  been  yellow 
fever,  namely,  those  at  Leghorn  in  18U4  and  at  Torre  Annunziata  in 
1883,  are  of  interest  because  of  the  heated  discussions  that  arose  as  to 
diagnosis  and  the  strenuous  opposition  that  was  made  against  branding 
the  affected  communities  with  the  name  of  yellow  fever,  conditions 


Section  A.  30 

recalling  the  story  of  many  an  epidemic  that  has  prevailed  in  various 
localities  in  the  United  States.  The  diagnosis  in  these  two  epidemics 
was  so  obscured  by  controversy  that  it  will  always  be  open  to  question. 
It  depends  upon  the  relative  value  that  the  student  of  their  history 
places  on  the  documentary  evidence  left  by  the  physicians  and  public 
officers  who  had  to  deal  with  the  disease. 

1804.  A  Spanish  ship,  the  Anna  Maria,  entered  the  port  of  Leghorn, 
August  18,  1804.  On  a  voyage  from  Havana  to  Cadiz  this  vessel  had 
lost  almost  the  entire  crew  from  yellow  fever.  At  Cadiz  the  ship  was 
refused  permission  to  enter  port,  but  was  allowed  to  recruit  the  crew 
in  quarantine.  Through  some  irregularity  the  Anna  Maria,  was  given 
clean  papers  at  Cadiz  and,  July  10,  passed  Gibraltar  and  proceeded  to 
Alicante,  where  she  received  free  pratique.  The  vessel  sailed  from 
Alicante  August  9,  and  reached  Leghorn  August  18.  Owing  to  the 
prevalence  of  yellow  fever  in  Spain,  special  sanitary  restrictions  had, 
since  July  17,  been  placed  on  all  vessels  arriving  at  Leghorn  from 
Spanish  ports.  There  had  been  sickness  on  board  the  Anna  Maria  on 
the  passage  from  Alicante  to  Leghorn.  The  declaration  of  the  captain, 
supported  by  oath,  and  the  liberal  donations  of  monev  made  by  the 
owner  of  the  cargo,  appear  to  have  been  effective  in  quieting  all  appre- 
hensions at  Leghorn.  The  ship  was  given  free  pratique.  Two  sick 
men  taken  from  aboard  were  carried  ashore  and  lodged  at  an  inn  in  the 
Strada  Pescheria  Yecchia.  These  men  died  three  days  after,  and  a  few 
days  later  12  persons  at  the  inn  were  taken  sick.  All  the  cases  ended 
fatally.  A  Neapolitan  who  had  left  the  inn  at  the  first  appearance  of 
the  disease  was  attacked  ten  days  after  and  died  in  another  neighbor- 
hood. A  French  butcher  who  took  breakfast  at  the  inn  in  the  Strada 
Pescheria  Vecchia  died  of  the  disease  in  ten  days.  Soon  after  his  wife, 
the  woman  who  owned  the  house  in  which  he  lived,  and  a  friend,  an 
officer  of  the  French  army,  died  of  the  same  affection.  At  the  time 
these  events  were  occurring  at  the  inn,  another  focus  was  formed  at  a 
bakery  in  the  Via  San  Antonio.  A  baker  had  brought  from  the 
infected  ship  a  quantity  of  sacks  which  were  to  be  filled  with  biscuits. 
The  bread  was  baked  in  the  night  and,  in  the  intervals  between  oven- 
fuls,  the  bakers  rested  themselves  by  lying  down  on  the  empty  bags. 
In  a  few  days  these  men  were  stricken  with  a  strange  malady.  Suspi- 
cion was  directed  against  the  Anna  Maria  as  the  source  of  the  disease, 
and  sanitary  guards  were  stationed  aboard.  In  their  turn,  the  guards 
acquired  the  disease. 

The  cargo  of  the  Anna  Maria  consisted  of  sugar,  hides,  and  wood  used 
in  the  art  of  dyeing,  and  was  stored  in  warehouses  in  different  parts  of 
the  city.  In  the  neighborhood  of  these  magazines  the  disease  gamed 
quick  headway.  The  porters  who  handled  the  goods  and  the  custodians 
of  the  warehouses  were  taken  with  the  disease.  Two  porters  and  1 
custodian  died.  .  Thus,  spreading  by  degrees,  the  malady  extended 
throughout  the  city  of  Leghorn.    At  that  period  Leghorn  had  a  popula- 


31 


Section  A. 


tion  of  60,000,  not  counting  the  men  of  the  French  garrison.  About 
7,000  inhabitants  fled  to  Pisa.  The  French  soldiers  were  transferred 
elsewhere.  Xone  of  these  persons  who  left  the  city  carried  the  disease 
to  their  new  residence. 

Two  French  physicians,  Lacoste  and  Dufour,  made  a  study  of  the 
malady.  Lacoste  had  been  for  many  years  a  medical  officer  of  the  army 
in  the  French  Antilles.  Dufour  was  a  sanitary  official  of  Leghorn  and 
had  conducted  many  necropsies.  Lacoste  and  Dufour  made  post- 
mortem examinations  of  the  bodies  of  the  French  butcher  and  the 
officer  of  the  French  army.  As  to  their  diagnosis,  they  only  reported 
that  the  men  died  of  a  contagious  disease.  They  did  not  assign  to  the 
disease  the  name  of  yellow  fever. 

After  the  flight  of  the  7,000  persons  to  Pisa,  a  sanitary  cordon  was 
thrown  about  Leghorn,  thus  cutting  the  city  off  from  the  rest  of  Tuscany. 
In  October,  the  government  of  Tuscany  sent  to  Leghorn  a  commission 
composed  of  the  celebrated  Professor  Palloni  and  Drs.  Bruni  and 
Bertini.  The  figures  showing  the  ravages  of  this  epidemic  are  very 
conflicting.  Lacoste  says  that  1,900  persons  died  during  the  epidemic, 
Coppie  says  1,500,  and  Palloni  700.  These  discrepancies  can  be  readily 
understood  when  account  is  taken  of  the  state  of  panic  that  prevailed 
and  the  confusion  that  invaded  the  families  of  the  sick  or  dead  when 
they  were  turned  out  of  their  houses  and  the  habitations  burned  to  the 
ground.  According  to  the  reports  of  Palloni,  there  were  7  deaths  in 
August,  51  in  September,  204  in  October,  390  in  November,  and  3  in 
December. 

The  government  commission  was  composed  of  men  of  experience  and 
learning,  who  studied  the  epidemic  thoroughly  and  suggested  the 
wisest  measures  of  sanitation.  But  it  is  a  curious  fact  that  when  it 
came  to  defining  the  malady  they  remained  mute.  The  only  conclusion 
that  can  be  drawn  is  that  silence  on  this  point  was  a  condition  imposed 
upon  them  by  their  government  with  a  view  to  minimising  the  com- 
mercial damage  that  in  a  maritime  city  would  be  attendant  upon  the 
epidemic  diagnosis  of  a  disease  capable  of  spreading  to  the  shipping. 
In  fact,  seventeen  years  after,  Palloni,  in  giving  his  advice  on  yellow 
fever  to  the  sanitary  authorities  of  the  port  of  Marseille,  confessed 
openly  that  there  had  been  at  Leghorn  in  1804  an  epidemic  of  yellow 
fever. 

1883.  The  small  epidemic  at  Torre  Annunziata  alleged  to  have  been 
yellow  fever  occurred  in  1883  on  the  eve  of  the  devastating  prevalence 
of  Asiatic  cholera  at  Naples  the  following  year.  The  interest  it  prob- 
ably would  have  otherwise  attracted  was  lost  in  the  greater  epidemic 
that  entirely  occupied  the  activity  and  study  of  Italian  physicians  and 
epidemiologists. 

The  first  case  occurred  June  19  in  the  person  of  a  tavern  keeper,  aged 
60,  from  Ischia.  This  man  went  directly  from  Ischia  to  Torre  Annun- 
ziata, May  29,  to  transact  business  as  a  wine  merchant.    His  case  was 


Section  A. 


32 


diagnosed  as  one  of  grave  icterus  and  lie  died  July  8,  in  Via  Oisterna. 
A  few  days  later  another  man,  80  years  old,  living  in  the  Via  del  Popolo, 
two  or  three  blocks  away,  died  with  the  same  symptoms.  The  attend- 
ing physicians  made  a  diagnosis  of  acute  yellow  atrophy  of  the  liver. 
The  third  case  was  that  of  a  woman  aged  70  years  who  died  August  25, 
after  an  illness  of  eight  days.  She  lived  in  Via  Garibaldi,  within  two 
blocks  of  the  first  cases.  The  same  diagnosis  of  acute  yellow  atrophy 
was  made. 

Early  in  September,  several  persons  living  in  Via  Oisterna  were  taken 
sick  about  the  same  time  and  with  the  same  symptoms.  An  alarm 
arose  and  strict  sanitary  measures  were  employed.  September  6,  a  cus- 
tom-house clerk  in  Via  Oisterna  was  taken'  ill.  He  had  a  chill,  pains 
in  the  back,  high  fever,  slow  pulse,  severe  headache,  and  black  vomit. 
He  died  in  7  days.  Cases  continued  to  appear  in  the  same  neighbor 
hood  until  October  13.  There  were  in  all  13  cases  and  7  deaths.  Tu 
September,  a  commission  of  medical  men  from  the  University  of  Naples 
investigated  the  disease.  Among  them  was  Professor  Somma,  who 
died  in  the  cholera  epidemic  at  Naples  the  next  year.  After  much  dis- 
cussion the  members  of  the  commission  admitted  the  specific  nature  of 
the  malady,  but  did  not  give  it  a  name.  However,  Professor  Somma, 
in  a  concise  letter  written  September  24,  1883,  to  Dr.  Gennaro  Cozzo- 
lino,  made  the  statement  that  the  disease  prevailing  at  Torre  Annun- 
ziata  was  yellow  fever.  During  the  height  of  the  epidemic  the  most 
careful  investigations  were  made;  necropsies  were  conducted  by  the 
most  skillful  pathologists  of  Naples;  a  special  lazaretto  was  estab- 
lished, and  the  most  stringent  measures  of  isolation  and  disinfection 
insisted  upon.  The  disputes  between  medical  men  were  numerous  and 
more  or  less  violent.  As  a  result,  the  consensus  of  opinion  excluded 
yeliow  fever.  Icteroid  typhus  and  infective  fever  characterized  by 
jaundice  were  the  diagnoses  settled  upon  by  the  different  physicians 
who  went  so  far  as  to  give  it  a  name. 

Since  1883.  It  is  a  frequent  occurrence  in  Italian  ports  up  to  the  pres- 
ent time  to  have  vessels  arrive  from  South  American  ports  with  a  his- 
tory of  yellow  fever  on  board  during  the  voyage.  But  no  cases  of  yellow 
fever  on  shore  have  been  registered  since  1883.  Vessels  with  suspicious 
histories  of  the  nature  mentioned  are  invariably  sent  for  disinfection  to 
the  Italian  national  lazaretto  on  the  island  of  Asinara. 

YELLOW  FEVER  IN  GEE  AT  BRITAIN. 

1817.  The  brig  Britannia,  from  Liverpool,  after  being  in  the  port  of 
Falmouth  for  six  weeks,  began  to  discharge  a  cargo  of  bales  of  cotton. 
No  sooner  had  the  unloading  begun  than  yellow  fever  developed,  but 
the  disease  was  limited  to  the  crew  of  the  vessel. 

1852.  In  the  month  of  November,  the  steamship  La  Plata  arrived  at 
Southampton  from  Saint  Thomas.    Yellow  fever  developed  aboard 


33 


Section  A. 


while  she  was  in  the  port  of  Southampton,  and  of  the  14  seamen  who 
were  taken  ill  7  died. 

1S57.  The  steamship  Tamar,  which  was  suspected  of  being  responsi- 
ble for  the  grave  epidemic  of  yellow  fever  at  Lisbon,  Portugal,  in  1857, 
entered  Southampton  shortly  afterwards.  She  had  had  deaths  on  the 
passage  from  Spain  and  gave  rise  to  several  cases  of  yellow  fever  at 
Southampton. 

1864.  In  this  year  there  were  a  few  cases  of  yellow  fever  aboard  a 
vessel  lying  in  the  harbor. 

1865.  In  the  month  of  September  a  sailing  vessel  arrived  at  Swansea 
from  Santiago  de  Cuba.  Yellow  fever  broke  out  aboard  while  she  was 
in  port  and  15  persons  died.    There  were  no  cases  reported  ashore. 

YELLOW  FEVER  IN  AUSTRIA. 

1894.  The  history  of  yellow  fever  in  Europe  concludes  with  2 
deaths  from  the  disease  in  hospital  in  Trieste.  The  Italian  steamship 
Colombo  returned  to  Genoa  from  Brazil,  having  had  yellow  fever  aboard. 
She  was  detained  for  disinfection.  Two  of  her  crew  went  by  land  to 
Trieste,  where  they  were  stricken  with  yellowfever  and  died  in  hospital. 
There  is  no  record  of  an  extension  of  the  disease. 

ACKNOWLEDGEMENTS. 

For  assistance  in  collecting  data  for  the  history  of  yellow  fever  in 
Europe,  acknowledgments  are  due  to  Professors  Delia  Valle  and  Mon- 
ti celli,  of  the  chairs  of  comparative  anatomy  and  zoology,  Uni verity 
of  Xaples,  for  information  regarding  the  mosquitoes  of  Europe;  to  the 
librarians  of  the  University  of  Naples  for  courtesies  extended  at  the 
library  ;  to  the  Sindaco  of  Torre  Annunziata  for  access  to  the  archives 
of  that  city,  and  to  Dr.  Enrico  Buonocore,  of  Naples,  for  valuable 
help  in  making  a  research  of  the  literature  of  the  subject. 

BIBLIOGRAPHY  OF  YELLOW  FEVER  IN  EUROPE. 

Tillers,  C. — C.  Linnaei  Enthomologia  faunae  Sueciae  aucta,  etc,  T. 
III.    Lugduni,  1789. 

Meigen,  J.  W. — Classification  und  Beschreib.  der  europ.  zwei- 
flueghischen  Insecten.    Braunschweig,  1804. 

Rondani. — Sulle  specie  italiane  del  genere  Culex.  Bolletino  della 
Societa  Entomologia  Italiana.    Anno  IV.    Firenze.  1872. 

Ficalbi,  Eugenio. — Bevisione  systematica  della  famiglia  delle  Culici- 
deae  Europee  (Genere  :  Culex,  Anopheles,  Aedes).    Firenze,  1896. 

Rapport  sur  l'epedemie  de  Fievre  jaune  de  Lisbonne  en  1857  par  le 
Conseil  de  Sant£  du  Royaume  de  Portugal. — Gazette  Medical  de  Paris, 
An  nee  34me,  3me  Serie,  volume  19me,  1864,  numbers  34-40,  page  533 
et  603. 


Section  A. 


34 


D.  Joaquim  de  Villalba. — Epidemiologia  espafiola,  o  historio  cro- 
nologica  de  las  pestes,  contagios,  epidemias  y  epizootias  que  han  acae- 
cido  en  Espana  desde  la  venida  de  los  Cartaginenses  que  han  sufrido  los 
Espanoles  en  otros  reynes,  y  de  los  autores  nacionales  que  han  escrito 
sobre  esta  materia,  asi  en  la  peninsula  como  fuera  de  ella.  Madrid' 
1802.    Volume  II. 

Moreau  de  Jonnes. — Monographie  historique  et  medical  de  la  fievre 
jaune  des  Antilles,  et  recherches  sur  les  lois  du  developpment  et  de  la 
propagation  de  cette  maladie  pestelentielle.    Paris,  1820. 

Ozanam. — Histoire  medicate  generate  et  particuli&re  des  maladies 
epidemique,  etc.    Paris,  1835.    Volume  3,  page  227,  et  seq. 

Encyclopedia  of  Medical  Sciences  — Italian  translation  by  M.  G.  Levi. 
Second  Division,  Volume  I.  Medical  Pathology  by  Joseph  Frank, 
page  445  et  seq.    Venice,  1837. 

Dechambre. — Dictionnaire  de  Medicine.    Article:  Fievre  jaune. 

D.  Jouan  Menuel  de  Arejula. — Breve  descripcione  de  la  fiebre  amar- 
illa  padecicla  en  Cadiz  y  pueblos  camercanosen,  1800  ;  en  Medina 
Sidonia,  1801  ;  en  Malagaen,  1803  ;  y  en  esta  misma  plaza,  y  varias 
otras  del  reyno  en  1804.    Madrid,  1806. 

Annali  Universali  di  Medicina,  Milano,  1802,  Volume  II,  November, 
1802.  Compilation  by  Annibale  Oinodei — Volume  II,  November,  1802, 
contains  a  relation  of  the  epidemics  in  Cadiz,  Seville,  and  other  i^laces 
in  Southern  Spain  by  the  Danish  consul  Schousboe  from  the  publica- 
tions of  the  Koyal  Danish  College  of  Economy  and  Commerce.  Volume 
XXIV,  October,  1822,  pages  103,  et  seq.,  contain  the  report  on  yellow 
fever  in  Barcelona  in  1821  made  by  the  National  Academy  of  Barce- 
lona in  compliance  with  an  extraordinary  decree  of  the  Cortes. 

Journal  Complementaire  du  Dictionaire  des  Sciences  Medicales  Paris, 
1822.— Vol.  8,  pages  193  to  217  (Mazet,  A.  Relation  abregee  d'un 
voyage  fait  en  Andalusie  pendant  l'epedemie  de  1819).  Also  Vol.  13, 
page  156. 

Bertulus. — La  Fievre  jaune  a  Barcelone  au  mois  d'Aout  dernier. 
Lettre  a  M.  le  Docteur  Guardia.  (Gazette  Medical  de  Paris,  18,- 
Fevrier,  1871.)  Des  principales  importations  de  fievre  jaune  en  Europe 
depuis  1800,  jusqu'  a  1862,  et  de  la  transmission  de  ce  fleau.  Lettre  a 
M.  le  Docteur  Jules  Gaerin,  Marseille,  4  Juillet,  1863.  (Gazette  Medi- 
cal de  Paris,  1  Aout,  1863.) 

Valevio  Arditi. — A  writing  containing  memoires  of  the  yellow-fever 
epidemic  in  Cadiz,  1800.    Lisbon,  1804. 

Arcere  (de  Foratoire). — Histoire  de  La  Rochelle.  Volume  2,  chap- 
ter 4,  La  Rochelle,  1756. 

M.  Melier. — Relation  de  la  fievre  jaune  survenue  a  S.  Nazaire  en  1861, 
lue  dans  les  seances  de  1' Academie  de  Medecine  dans  les  seances  des  7,  14, 
21  et  28  Avril,  1863.  Paris,  1863.  Memoires  de  V  Academie  de  Mede- 
cine, volume  26me. 


35 


Section  A. 


H.  de  Gonvea.—  Le  Bulletin  Medical.  Paris,  October  12,  1901.  Les 
Moustiques  et  la  fievre  jaune. 

Angelo  Moretti. — Opuscoli  sulla  malatia  di  Livorno,  tradutti  dal 
Fraucese  in  Italiano.    Siena,  1805. 

Savaresy. — De  la  fievre  jaune  en  general  et  particulierement  de  celle 
»iui  a  regne  a  la  Martinique  en  Tan  XI  et  XII  (1803  et  1804)  2  volumes. 
Naples,  de  l'imprinierie  Francaise,  1809. 

Various  documents  in  the  municipal  archives  of  Torre  Annunziata. 

Encyclopaedia  Britannica,  Article,  Yellow  Fever. 


wo  .  <\ 
dry  ■' 


YELLOW   FEVER  INSTITUTE,  BULLETIN  No.  9 

Treasury  Department,  Public  Health  and  Marine-Hospital  Service. 
WALTER  WYMAN,  Surgeon-General. 


Are  Vessels  Infected  with  Yellow  Fever? 


SOME  PERSONAL  OBSERVATIONS. 


By  Surgeon  H.  S.  CABTEE. 


JULY,  1902. 


WASHINGTON: 

GOVERNMENT  PRINTING  OFFICB. 
1902. 


HHHYB,TffAr\  | 

STATE  OTlIVCTttTS , 


YELLOW 

Treasury 


FEVER  INSTITUTE,  BULLETIN  No. 

Department,  Public  Health  and  dlarine-Hospital  Service. 
WALTER  WYMAN,  Surf/eon- General. 


9. 


Are  Vessels  Infected  with  Yellow  Fever? 

SOME  PERSONAL  OBSERVATIONS. 

By  Surgeon  H.  R.  CARTER. 


JULT,  1902. 


WASHINGTON: 

GOVEENMENT  PRINTING  OFFICE. 
1902. 


% 


YELLOW  FEVER  INSTITUTE, 

Treasury  Department,  Public  Health  and  Marine-Hospital  Service, 
WALTER  WYMAN,  Surgeon-General. 

Bulletin  No.  9. 

Section  C— TRANSMISSION.  J.  H.  WHITE,  Asst.  Surg.  General,  Chairman  of  Section. 


ARE  VESSELS  INFECTED  WITH  YELLOW  FEVER  ?— SOME  PERSONAL 
•  OBSERVATIONS. 

By  Surgeon  H.  R.  Carter. 


JULY,  1902. 


In  a  paper  read  before  the  American  Public  Health  Association  at 
\jf  Buffalo,  September  18,  1901,  Dr.  Doty,  the  quarantine  officer  of  New 
York,  affirms  the  absence  of  secondary  cases  of  yellow  fever  aboard  ves- 
sels— i.  e.,  that  while  cases  of  this  disease  contracted  ashore  develop 
aboard  vessels,  yet  none  are  contracted  aboard  the  vessel  itself — that 
is,  the  vessel  does  not  become  ' '  infected ' '  with  yellow  fever. 

The  experience  of  other  quarantine  officers  has  been  different,  and  it 
may  be  of  service  then  to  group  some  cases  already  of  record  in  which 
the  contrary  was  observed.    It  is  not  proposed  to  collate  a  number  of 
examples  of  vessels  aboard  which  yellow  fever  was  contracted,  from  the 
literature  of  the  subject,  but  to  give  very  briefly  the  history  of  some 
such  vessels  personally  observed  by  the  writer,  from  his  own  notes, 
during  a  four  years'  service  (1888  to  1891,  inclusive)  at  the  quarantine 
p  of  the  Gulf,  Chandeleur  and  Ship  islands.    Here  were  received  all  ves- 
sels believed  to  be  infected  with  yellow  fever  bound  for  all  of  the  Gulf 
\       ports,  except  for  New  Orleans  and  from  Tampa  south.  Consequently 
^  our  clientele  was  considerable.    The  bulk  of  them,  however,  although 
.  certainly  the  worst  class  of  vessels  which  entered  the  Gulf  of  Mexico, 
were  not,  in  my  opinion,  "infected"  when  I  received  them — i.  e.,  yel- 
low  fever  could  not  then  have  been  contracted  aboard  them. 

I  will  premise  here  that  I  accept  without  reservation  the  conveyance 
of  yellow  fever  by  an  infected  mosquito  of  a  certain  kind,  and  that  to 

2  SEC.  c.  7 


Section  C. 


8 


me  a  vessel  ' 1  infected"  with  yellow  fever  is  simply  one  which  is  har- 
boring these  infected  mosquitoes.  Whether  they  came  aboard  already 
infected  or,  being  aboard,  became  infected  by  feeding  on  cases  of  yellow 
fever  developing  aboard  ship  but  contracted  ashore,  can  in  general  be 
determined  from  the  history  of  the  spread  of  the  infection.  Indeed,  it 
was  primarily  the  history  of  these  and  other  ships  which  led  to  the 
(tentative)  formulating  of  the  laws  of  the  "  interval  between  the  infect- 
ing and  secondary"  cases  of  yellow  fever  and  the  ''period  of  extrinsic 
incubation  of  places"  of  that  diease,  which,  and  much  else,  are  so 
clearly  explained  by  the  conveyance  by  a  mosquito  host. 

The  deductions  as  to  the  disease  being  contracted  aboard  the  vessels, 
when  such  deduction  is  made,  are,  however,  independent  of  the  assump- 
tion of  any  theory  of  conveyance.  I  do  assume,  however,  that  the 
period  of  incubation  of  yellow  fever,  rarely,  if  ever,  exceeds  six  or  six 
and  one-half  days. 

1888. — SHIP  ISLAND. 

I.  Norwegian  bark  Magnolia,  946  tons,  fifty-six  days  from  Rio  de 
Janeiro  via  Pensacola  Bar,  rock  ballast.  Left  Rio  de  Janeiro  May  20  ; 
left  2  men  sick  in  hospital  and  had  1  aboard,  considered  yellow  fever. 
Master  sick  third  day  out,  May  22  ;  died,  May  27.  All  well  till  June  1, 
then  several  (3)  got  sick  at  once.  First  mate  sick,  June  11 ;  died,  June 
17 ;  black  vomit.  All  were  sick  on  the  way  up  except  2  ;  21  on  crew 
list  including  the  2  men  left  in  Rio  de  Janeiro.  One  of  these  who 
escaped  fever  had  had  yellow  fever,  and  the  other  was  a  lad  from  Dantzig 
on  his  first  deep-sea  voyage.  In  all  17  men  were  sick  of  fever  en  route, 
of  whom  5  died.  The  last  case,  Elias  Eliasen,  developed  June  14. 
Here,  save  the  captain,  all  sickened  not  less  than  eleven  days  after 
leaving  Rio  de  Janeiro,  and  the  first  mate  and  Eliasen  on  the  twenty - 
third  and  twenty-sixth  day,  respectively.  They  then  contracted  yellow 
fever  aboard  ship. 

The  picture  is  that  of  an  infection  introduced  aboard  the  vessel  by 
the  men  who  sickened  in  Rio  de  Janeiro — i.  e.,  there  were  uninfected 
stegomyise  aboard  which  were  infected  from  these  cases  and  conveyed 
yellow  fever  to  the  remainder  of  the  crew,  except  the  captain,  who  con- 
tracted it  ashore.  I  did  not  record  the  dates  of  the  cases  of  the  men 
left  at  Rio  de  Janeiro ;  it  was  shortly  before  clearing.  The  interval 
between  an  infecting  and  a  secondary  case  is  almost  always  fourteen 
days  or  over. 

II.  Italian  bark  Biagino,  Rio  de  Janeiro,  for  Pensacola,  fifty- one  days 
out ;  rock  ballast,  560  tons.  No  sickness  in  Rio  de  Janeiro  until  just 
before  leaving,  then  sent  2  men  to  hospital.  Left  five  days  after. 
Log  shows  men  were  taken  June  4  and  June  6  and  removed  on  June  6. 
Sailed  on  June  10.  No  one  had  been  ashore  save  master  and  steward, 
using  a  harbor  boat. 

First  case  reported  sick  en  route  June  21 ;  1  next  day  ;  6  sick  en  route  ; 


9 


Section  C 


3  deaths,  June  28,  June  29,  and  July  14,  all  with  black  vomit.  Crew 
refused  duty  at  second  death.  Last  case  well  July  13.  Sixteen  on 
crew  list ;  2  in  Rio  de  Janeiro.  Master  had  had  yellow  fever ;  steward 
sick  just  after  leaving,  not  considered  yellow  fever. 

Six  cases  developed  ten  days  after  leaving  Rio  de  Janeiro.  Same 
remarks  as  were  made  of  the  Magnolia  apply  here. 

No  record  is  made  of  where  these  2  vessels  lay  in  Rio  de  Janeiro,  the 
writer  not  then  appreciating  the  importance  of  this. 

18S9. 

My  notes  for  1889  are  lost,  and  iudeed  there  may  have  been  in  1888 
more  than  the  2  vessels  given  above,  which  should  have  been  included 
in  this  paper  ;  but  my  notes,  taken  at  first  solely  with  the  view  of 
determining  the  period  of  incubation  of  yellow  fever,  give  data  on  only 
these  two  sufficiently  definite  to  determine  that  they  were  infected — 
i.  e.,  that  yellow  fever  was  contracted  aboard. 

1890. 

III.  British  ship  Avon,  in  rock  ballast ;  22  in  crew,  4  immune  to  yellow 
fever.  Sailed  from  Rio  de  Janeiro  April  20.  All  well  in  port  and  en 
route  until  thirty- eight  days  out,  when  a  boy  in  port  watch  sickened 
with  yellow  fever.  Taken  to  hospital,  Gulf  Quarantine,  on  third  day, 
and  died  on  sixth  day.  Another  case  developed  two  weeks  later  in  a 
quarantine  attendant  who  helped  me  clean  up  the  room,  sail  locker,  in 
which  the  boy  was  sick  aboard  ship. 

It  is  remarkable  that  there  should  have  been  only  1  case  of  yellow 
fever  among  the  crew  aboard  this  vessel.  At  the  time  it  was  ascribed 
to  the  fact  that  this  boy,  the  only  one  on  the  port  watch,  helped  a  man, 
shipped  in  Rio  de  Janeiro  and  immune  to  yellow  fever,  overhaul  his 
chest  a  few  days  before  the  boy  was  taken  sick.  Whether  there  was  an 
infected  mosquito  in  the  chest  which  had  survived  this  length  of  time, 
or  whether  there  was  any  relation  between  the  chest  and  the  fever,  may 
be  a  question.  It  in  no  wise  affects  the  y resent  question,  that  the  dis- 
ease was  contracted  aboard.  It  was  the  first  case  seen  at  this  station 
that  year. 

IY.  British  ship  Curlew,  from  Rio  de  Janeiro,  with  rock  ballast. 
No  sickness  was  reported  en  route,  in  port,  or  on  arrival.  She  was 
cleaned  July  22  to  July  23,  1890,  and  disinfection  completed  July  25,  in 
the  afternoon.  One  case  of  yellow  fever  developod  July  27,  the  sixty- 
fourth  day  out,  in  the  early  morning  before  day. 

V.  British  ship  Chippewa,  from  Rio  de  Janeiro,  with  rock  ballast. 
No  sickness  was  reported  in  port,  en  route,  or  on  arrival.  She  was 
cleaned  July  26  and  July  27,  and  disinfection  completed  July  28.  One 
man,  the  quartermaster,  developed  yellow  fever  July  29,  at  night,  sixty- 
eight  days  out  from  Rio  de  Janeiro. 


Section  C. 


10 


The  Avon  made  no  port  after  leaving  Rio  de  Janeiro  and  communi- 
cated with  no  vessel  en  route.  The  other  2  made  no  port  save  Pensa- 
cola  Bar,  and  communicated  with  no  vessel  save  the  pilot  boats  there 
and  off  Mobile  Bar.  The  infection  in  these  3  vessels,  then,  must  have 
been  contracted  aboard.  They  lay  in  open  roadstead  at  my  station,  H 
miles  off  shore  and  about  $  mile  apart,  and  there  was  no  visiting 
between  them  and  none  of  their  crews  was  ashore. 

VI.  Spanish  bark  Castilla,  fifteen  days  from  Cienfuegos  via  Eound 
Island  Quarantine,  in  rock  and  earth  ballast  ;  14  in  crew.  Eight  days 
out  from  Cienfuegos  to  Round  Island.  All  well  in  port,  en  route, 
and  on  arrival.  Mate  sickened  fourth  day  after  arrival  at  Round 
Island  while  discharging  ballast.  Vessel  sent  here  in  tow  August  22. 
Mate  had  yellow  fever ;  died  on  the  sixth  day  of  illness.  Captain 
developed  yellow  fever  day  after  mate's  death  ;  taken  to  hospital.  No 
other  cases  of  sickness  aboard  ;  the  remainder  of  the  crew  are,  save  1, 
Manila  men,  and  all  probably  immune  to  yellow  fever,  being  mainly 
residents  of  Cuba  for  many  years. 

Here  2  men  developed  yellow  fever,  1  twelve  and  1  seventeen  days 
after  leaving  Cienfuegos.  The  infecting  mosquitoes  may  well  have  been 
harbored  in  the  hold,  which  the  mate  would  probably  not  have  visited 
until  he  anchored  at  Round  Island  and  began  discharging  ballast,  and 
in  which  the  master  wo  aid  not  be  apt  to  go  while  the  mate  was  on  duty. 

VII.  Spanish  bark  Grand  Canaries,  seven  days  out  from  Havana 
July  7.  All  well  in  port,  en  route,  and  on  arrival  and  while  in  quar- 
antine. Crew  probably  all  immune  to  yellow  fever,  being  mainly 
Manila  men  and  old  residents  of  Havana. 

O.  F. ,  quarantine  employe,  went  aboard  as  ballast  master ;  next  day 
developed  yellow  fever,  July  11.  This  man  had  been  exposed  to  no 
possible  source  of  infection  for  the  six  months  previous  except  this 
vessel.  A  case  nearly  similar  to  the  above  occurred  in  1889,  but  I  have 
no  notes  of  it. 

VIII.  Norwegian  bark  Queen  of  the  Seas,  in  rock  ballast,  Rio  de 
Janeiro  for  Pensacola,  fifty-four  days  out.  Left  Rio  de  Janeiro  with  17 
men  ;  6  deaths  en  route.  All  well  in  Rio  de  Janeiro.  Lay  at  Mocanque, 
a  healthful  part  of  harbor.  None  save  master  allowed  ashore,  but  he 
went  in  ship's  boat.  Left  1  man  at  Rio  de  Janeiro — consumption. 
Shipped  1  man,  a  negro,  in  his  place.  Sailed  April  23 ;  master  sick 
April  26;  second  mate  sick  night  of  May  10;  2  men  May  11;  1  man 
May  12 ;  2  men  morning  of  13th ;  2  during  day  of  13th ;  1  man  sick  and 
1  died  15th ;  1  man  died  17th  ;  2  sick  17th  ;  1  died  19th ;  2  died  21st  and 
22d;  1  sick  21st;  1  died  25th;  13  sick  en  route,  5  died.  The  man 
shipped  in  Rio  de  Janeiro  (negro)  and  1  of  the  others  immune  by  pre- 
vious attack.  The  picture  is  very  clear  of  a  clean  ship,  infected  by  the 
illness  of  the  master  contracted  ashore — i.  e.,  had  uninfected  mosquitoes 
aboard,  which  became  infected  from  the  master  sick  of  yellow  fever, 
and  conveyed  it  to  the  crew. 


11 


Section  C. 


1891. 

IX.  British  ship  Curleiv,  fifty-seven  days  from  Eio  de  Janeiro  for  Pen- 
sacola.  Lay  in  the  Gamboa  last  eight  days.  Two  men  sick  February 
27,  taken  to  hospital  that  day  ;  sailed  March  1.  Master  sick  March  1 ; 
5  men  besides  him  that  night.  Two  men  March  4,  1  March  5,  and  2 
more  during  the  day.  Two  men  sick  March  7.  Two  men  died  the  19th, 
sickening  the  13th  and  15th,  respectively,  both  with  black  vomit.  All 
aboard  here,  19,  were  sick  en  route  except  1,  a  Barbados  negro ;  but 
don't  believe  all  had  yellow  fever,  the  crew  having  been  badly  fright- 
ened. The  earlier  cases  and  the  3  who  died  were  undoubtedly  yellow 
fever,  as  were  the  steward  and  mate.  Here  we  have  2  cases,  at  least, 
developing  thirteen  and  fifteen  days  after  leaving  Eio  de  Janeiro. 

X.  Swedish  ship  Condoren,  seventy-nine  days  out  from  Eio  de  Janeiro 
via  Pernambuco  for  Mobile.  Eock  and  earth  ballast ;  18  in  crew. 
All  well  in  port.  Lay  in  Gamboa  last  five  days.  No  shore  leave 
allowed,  but  took  ship's  boat  to  go  ashore.  Sailed  March  3  ;  3  men  sick 
March  5  ;  16  men  sick,  all  told,  up  to  March  26,  and  6  deaths.  Last  man 
got  sick  March  26,  when  she  put  into  Pernambuco  short-handed  and 
sent  3  sick  men  to  hospital.  Two  men  sick  March  20  ;  4  men  sick  March 
18  ;  1  man  sick  March  26  (really  night  of  25th).  At  Pernambuco  she 
lay  eleven  days  and  was  disinfected  by  sulphur.  Shipped  8  new  men, 
4,  probably  5,  of  them  immune  to  yellow  fever.  Developed  no  sickness 
on  the  rest  of  the  way  up.  Here  4  men  developed  yellow  fever  fifteen 
days  from  Eio  de  JaDeiro. 

XL  German  ship  Gustav  and  Oscar,  Eio  de  Janeiro  for  Pensacola. 
Lay  at  Cobras,  a  healthful  place.  One  case  yellow  fever  at  Eio  de 
Janeiro,  March  22,  sent  to  hospital  March  24.  No  shore  leave  allowed. 
Sailed^from  Eio  de  Janeiro  April  1 ;  first  case  sickness  April  7,  2  men  ; 
3  next  day  ;  1  next  morning,  and  2  during  the  day  of  the  9th.  One 
death  on  the  10th,  leaving  6  men  sick.  Captain  sick  on  the  10th  at 
night  after  supper.  Last  case  on  14th.  Two  deaths  on  11th  ;  1  on  12th. 
Crew  list  shows  2irmen  left  Eio  de  Janeiro  ;  14  sick  and  4  deaths  en 
route.  It  is  reasonably  certain  that  4  of  the  remaining  crew  were 
immune  to  yellow  fever  by  previous  attack. 

XII.  Norwegian  bark  Croicn  Prince,  fifty- eight  days  out  from  Eio  de 
Janeiro  for  Ship  Island.  Lay  at  Moncanque.  No  sickness  aboard  in 
Eio  de  Janeiro.  No  shore  leave  granted,  and  did  not  use  ship's  boat 
to  go  ashore.  Sailed  April  29.  Master  sick  second  day  out  (April  30). 
2s'ext  case  May  16 ;  3  (2  aft  and  1  forward)  became  sick.  May  17,  2  . 
sick  in  morning,  1  in  the  day.  May  18,  3  men  in  forecastle  sick.  May 
20,  2  sick,  1  death.  May  21,  1  death,  1  sick.  May  23,  2  deaths.  May 
24,  1  sick.  May  28,  1  death  last  night.  May  29,  1  sick  this  morning. 
M  1  death.    The  1  case  on  the  29th  was  the  last  case  taken  sick. 

There  were  14  men  aboard  and  every  man  had  fever,  6  dying.  She  put 
into  Barbados  on  June  10,  disinfected  and  shipped  (in  quarantine)  4 


Section  C. 


12 


new  men,  1  probably  unacclimated.  No  more  sickness  en  route.  All 
of  these  cases  except  the  captain's  were  not  less  than  sixteen  days  from 
Rio  de  Janiero  before  developing. 

XIII.  French  ship  Emily  Postel,  twelve  days  from  Vera  Cruz  via 
Pensaeola  quarantine.  Had  " sickness"  aboard  just  before  leaving 
Vera  Cruz,  1  man.  Sailed  from  Vera  Cruz  July  28 ;  no  sickness  since 
until  crew  went  to  discharge  ballast,  August  12.  One  man  sick  yellow 
fever  August  15,  2  men  the  same,  August  19,  and  1  man  August  20. 
Disinfection  by  sulphur  was  done  on  the  appearance  of  the  first  case  of 
yellow  fever  and  no  case  occurred  save  the  above.  All  were  developed 
more  than  sixteen  days  after  leaving  Vera  Cruz,  hence  from  infection 
on  board.  The  history  points  to  infection  (infected  mosquitoes)  in  the 
hold. 

The  picture  given  by  the  Curlew  and  Conderen  are  those  of  disease 
conveyed  by  mosquitoes  coming  aboard  already  infected  just  before 
they  sailed.  The  infection  was  not  introduced  by  the  men  who  first 
sickened,  the  interval  between  them  and  the  next  cases  was  too  short. 
Observe  that  they  lay  in  the  Gamboa,  directly  in  the  lee  of  a  town 
badly  infected.  The  other  two  give  the  usual  history  of  a  clean  place 
(town  or  vessel)  infected  by  some  one  developing  yellow  fever,  con- 
tracted elsewhere,  in  it. 

XIV.  Dr.  G.,  assistant  surgeon  U.  S.  Marine-Hospital  Service, 
developed  yellow  fever  June  18  at  the  Gulf  Quarantine  Station,  and 
died  June  29.  He  was  immediately  from  New  York,  where  he  had  been 
on  duty  some  months,  and  had  been  at  the  station  but  fourteen  days 
when  he  was  taken  ill.  There  had  been  no  case  of  yellow  fever  at  the 
station  that  year.  There  were  a  number  of  vessels  in  quarantine,  but 
the  Gustav  and  Oscar  (No.  XI)  was  the  only  one  I  judged  to  be  infected. 
On  this  vessel,  as  on  the  others,  he  had  been  with  me  inspecting, 
opening  up  drawers  and  boxes,  and  going  into  every  compartment,  etc., 
for  the  disinfection.  I  thought  his  infection  was  from  this  vessel.  It 
was  certainly  from  some  vessel. 

I  think  it  will  be  granted  from  the  above  that  the  ability  of  a  vessel 
to  carry  the  infection  of  yellow  fever  is  no  myth.  Here  are  13  vessels 
which  did  so  carry  it  collated  from  only  three  years'  observation  at  a 
single  station.  Such  vessels  are  indeed  rarer,  much  rarer,  now  than 
they  were  before  1894,  yet  they  still  come.  I  saw  2  at  Tortugas  in  1894. 
Other  cases  are  reported  by  Geddings  and  by  Echemendia  at  the  same 
place  and  at  Port  Tampa  quarantine.  Rosenau  reports  a  case  con- 
tracted aboard  the  steamship  Vigilancia,  from  New  York,  plying  between 
New  York  and  Vera  Cruz  via  Havana,  in  1899.  The  steamship  Bodo, 
last  year  (1900),  from  Bocas  del  Toro,  for  Mobile,  developed  3  cases  of 
yellow  fever,  seven,  eight,  and  nine  days  out  from  Bocas  del  Toro.  It 
would  not  be  difficult,  I  think,  to  multiply  instances  of  recent  date,  yet 
that  they  are  rarer  is  without  question.  On  the  factors  which  have 
brought  this  about  we  can  barely  touch. 


13 


Section  C. 


Obviously  there  are  two  methods  by  which  vessels  can  become 
infected,  (a)  A  case  of  yellow  fever  contracted  elsewhere  may  develop 
aboard  a  vessel  already  harboring  stegomyia  mosquitoes  which  become 
contaminated  from  it.  (b)  The  stegomyia  mosquitoes  may  come  aboard 
already  contaminated.  In  the  first  case,  there  being  nearly  always  over 
two  weeks  between  the  infecting  and  the  first  secondary  cases  of  yellow 
fever,  it  results  that,  if  the  first  case  occurs  after  leaving  port,  vessels, 
even  sailing  vessels,  from  Cuba  and  the  Caribbean  Sea  will  generally 
reach  quarantine  and  (if  at  a  southern  station)  be  disinfected — i.  e., 
mosquitoes  killed,  before  it  is  time  for  the  secondary  cases  to  develop, 
or,  indeed,  to  be  contracted.  This  agrees  with  all  observation.  In 
vessels  infected  in  the  second  way,  cases  of  yellow  fever  may  occur 
after  a  very  short  or  no  interval  from  leaving  port.  The  causes,  then, 
which  have  lessened  the  number  of  infected  vessels  at  United  States 
ports,  are — 

1.  The  very  great  falling  off  of  vessels  from  Eio  de  Janeiro  and 
Santos  since  the  establishment  of  the  Brazilian  Eepublic.  This  does 
away  with  the  bulk  of  the  "long-trip  vessels"  we  used  to  have,  which 
are  the  only  ones  developing  secondary  cases  en  route  if  infected  by  a 
case  of  yellow  fever  developing  aboard.    (Vide  a.) 

2.  The  replacing  of  sailing  craft  by  steamships.  That  steamers  con- 
vey yellow  fever  less  frequently  than  sailing  vessels  has  long  been  known. 
This  is  because  they  lie  a  much  less  time  in  an  infected  port,  and  the 
discipline  of  their  crews  is  better  ;  no  shore  leave  means  no  man  goes 
ashore.  They  also  make  quicker  trips,  and  thus  are  not  apt  to  develop 
secondary  cases  en  route,  even  if  yellow  fever  contracted  elsewhere 
develops  aboard  and  they  have  the  stegomyia  aboard.  It  is  also  to  be 
noted  that  the  worst  parts  of  the  harbors  of  Havana  and  Eio  de  Janeiro, 
above  San  Jose  wharf  and  the  Gamboa,  have  never  been  berths  for 
steamships.  Xote,  too,  that  the  sailing  vessels  displaced  are  the  foreign 
sailing  vessels ;  the  American  schooner  was  less  often  infected  than 
foreign  vessels. 

3.  Especially  since  1893,  and  to  some  extent  before  supervision  had 
been  kept  by  United  States  sanitary  inspectors  in  the  more  dangerous 
yellow- fever  ports  over  vessels  bound  for  the  United  States,  especially 
of  passenger  vessels.  Certain  anchorages  have  been  recemmended  as 
safe,  others  have  been  forbidden,  notably  the  Gamboa  at  Eio  de  Janeiro 
and  certain  wharves  and  parts  of  the  harbor  at  Havana.  Passengers 
who  it  is  believed  will  develop  infection  aboard  have  been  barred  j  ship- 
ment of  new  men  in  the  infected  port  carefully  supervised ;  vessels  in 
which  yellow  fever  has  occurred  in  port  are  disinfected  before  leaving, 
and  many  other  measures  taken  to  have  the  vessel  leave  port  clean,  or 
as  nearly  clean  as  commercial  considerations  allow.  In  general,  the 
vessel  owners,  especially  of  the  regular  lines,  have  given  hearty  coopera- 
tion in  these  measures,  as  well  as  in  keeping  the  crew  aboard  and  in 
confining  the  visits  of  such  officers  as  must  go  ashore  to  daylight. 

3  SEC.  c. 


Section  C. 


These  restrictions,  especially  the  last,  have  by  no  means  been  absolute 
for  all  classes  of  vessels,  but  are  well  observed,  in  Cuban  and  Mexican 
ports  at  least,  by  probably  over  five-sixths  of  the  tonnage.  The  sani- 
tary measures  to  avoid  infection  (3)  and  the  proportionate  substitution 
of  foreign  sailing  vessels  by  steamships  (2)  are  without  doubt  the  main 
factors  acting  in  cooperation  in  lessening  the  infection  of  ships.  No 
one  can  read  Burgess'  list  of  infected  vessels  in  Havana  Harbor  (Report, 
U.  S.  Marine- Hospital  Service,  1896)  without  noting  how  great  has  been 
that  decrease  in  recent  years. 

We  have  said  that  if  a  case  of  yellow  fever  develops  aboard  a  vessel 
harboring  the  stegomyia  mosquito  (proper  conditions  of  temperature 
being  premised)  that  they  may  become  contaminated  by  feeding  on  him 
and  infect  others.  A  vessel  which  has  no  stegomyia  aboard  is  like 
u noninfectible  territory"  and  will  not  communicate  infection,  even  if 
cases  of  yellow  fever  develop  aboard.  I  think  it  fair  to  say  that  ves- 
sels plying  to  and  from  southern  ports  of  the  United  States  will,  during 
the  summer  season,  generally  have  the  stegomyia  aboard,  independently 
of  its  berth  in  tropical  harbors,  and  may  at  times  breed  them  in  their 
water  supply.  This  mosquito,  however,  seems  to  be  rare  north  of  Vir- 
ginia Beach  (its  distribution  has  not  been  sufficiently  investigated, 
however),  and  a  vessel  plying  to  and  from  a  northern  port  of  the  United 
States  would  not  harbor  this  mosquito  unless  it  came  aboard  in  the 
tropical  port.  Now  how  far  this  mosquito  goes  or  is  borne  from  shore 
has  not,  I  think,  been  directly  investigated,  but  we  do  know  that  the 
crews  of  vessels  moored  off  from  shore  (say  200  or  more  fathoms)  in 
that  part  of  Havana  harbor  seaward  from  the  line  between  the  Sta. 
Catalina  warehouses  and  the  Machina  wharf  do  not  develop  yellow 
fever  (unless  close  to  some  vessel  which  is  infected).  This  means  that 
contaminated  stegomyia,  at  least,  do  not  go  so  far  from  shore.  Lying 
then  at  the  anchorages  accounted  safe  in  Havana  harbor,  where  the 
passenger  vessels  for  the  United  States  lie,  one  would  think  that  the 
probability  of  any  stegomyia  coming  aboard  would  be  small.  At  Vera 
Cruz  the  vessels  must  lie  nearer  shore  (although  to  windward  of  it), 
and  experience  shows  that  the  crews  of  vessels  lying  there  are  not  entirely 
safe,  as  I  believe  them  to  be  in  Havana,  although  infection  in  the  part  of 
the  harbor  picked  out  as  safe  is  decidedly  rare.  The  anchorages  in  both 
harbors  regarded  as  safe  are  well  to  the  windward  of  the  town  all  sum- 
mer. A  direct  investigation  of  this  matter — i.  e.,  the  presence  of  the 
stegomyia  aboard  vessels  from  northern  ports  in  different  parts  of  the 
harbor  of  Havana  and  other  tropical  harbors,  should  be  made. 

To  sum  up — 

1.  Vessels  aboard  which  yellow  fever  had  been  contracted — i.  e., 
vessels  infected  with  yellow  fever  have  not  been  rare,  at  least  at  south- 
ern quarantine  stations. 

2.  Such  vessels  are  much  rarer  since  1893,  and  are  not  very  common 
now. 


15 


Section  C 


3.  That  the  diminution  of  the  number  of  infected  vessels  reaching 
United  States  ports  is  due  mainly  to  the  sanitary  measures  for  avoiding 
exposure  to  infection  in  the  foreign  port,  and  to  the  substitution  of  steam 
for  sailing  vessels.  To  some  degree  the  falling  off  of  the  vessels  from 
Brazilian  ports  is  also  a  factor. 

4.  That  a  case  of  yellow  fever  developing  aboard  a  vessel  plying 
between  southern  ports  of  the  United  States  and  the  tropics  will  prob- 
ably infect  the  vessel  so  that  other  cases  can,  if  time  be  given,  be  con- 
tracted aboard  her. 

5.  Such  vessels,  however,  if  short-trip  vessels,  not  more  than  ten  or 
twelve  days  en  route  after  the  occurrence  of  the  case  of  yellow  fever, 
will  in  general  be  disinfected  at  southern  quarantine  stations  before  any 
other  cases  have  been  contracted  aboard,  although  harboring  infected 
mosquitoes. 

6.  That  a  case  of  yellow  fever  so  occurring  aboard  a  vessel  from  a 
northern  port  of  the  United  States  would  be  able  to  infect  her  or  not 
according  to  whether  she  had  acquired  the  mosquitoes  stegomyia  fas. 
in  the  tropical  port. 

7.  It  is,  in  general,  then  necessary  to  disinfect  all  vessels  running 
between  southern  ports  of  the  United  States  and  tropical  ports  if  a  case 
of  yellow  fever  occurs  aboard,  no  matter  where  it  be  contracted  ;  while 
vessels  running  between  northern  ports  and  the  tropics  may,  through 
precautions  in  tropical  harbors,  have  no  stegomyia  aboard  and  are  thus 
not  infectable  by  cases  of  yellow  fever  occurring  aboard. 

8.  Some  vessels  giving  no  history  of  yellow  fever  in  port,  en  route, 
or  on  arrival — even  when  many  days  en  route — are  nevertheless  infected 
and  communicate  the  yellow  fever  to  those  who  go  aboard,  vide  Nos. 
IV,  V,  VI,  VII.  Note,  also,  the  first  case  aboard  the  Avon,  No.  Ill,  was 
thirty-eight  days  out  from  Rio  de  Janeiro.  This  is  probably  due  to  the 
infection  (infected  mosquitoes)  in  parts  of  the  vessels  unfrequented  by 
the  crew  while  en  route,  or  to  the  crew  being  all  immune  to  yellow  fever. 


► 


YELLOW  FEVER  INSTITUTE,   BULLETIN  No.  1G. 

Treasury  Department,  Bureau  of  Public  Health  and  Marine- Hospital  Service. 
WALTER  WYMAN,  Surgeon-General. 


THE  METHODS  OF  THE  CONVEYANCE 


OF 


YELLOW  FEVER  INFECTION. 


By  Surgeon  H.  R.  CARTER. 


JULY,  1902. 


WASHINGTON: 

GOVERNMENT   PRINTING  OFFICE. 

1902. 


HENRY  B,  WARD, 

STATE  UNIVEBSTT 


YELLOW   FEVER   INSTITUTE,    BULLETIN    No.  1<). 

Treasury  Department,  Hureau  of  Public  Health  and  Marine-Hospital  Service. 
XV ALTER  WYMAN,  Surgeon-General. 


THE  METHODS  OF  THE  CONVEYANCE 


OF 


YELLOW  FEVER  INFECTION. 


By  Surgeon  H.  R.  CARTER. 


JULY,  1902. 


WASHINGTON: 

GOVERNMENT   PRINTING  OFFICE. 

1902. 


Vu>  '10 

YELLOW  FEVER  INSTITUTE. 

Treasury  Department,  Bureau  of  Public  Health  and  Marine-Hospital  Service. 
WALTER  WTMAN,  Surgeon-General. 

Bulletin  No.  10. 
Section  C. — TRANSMISSION  Asst.  Sar^.-Gen.  J.  H.  WHITE,  Chairman. 


THE  METHODS  OP  CONVEYANCE  OP  YELLOW  PEVEK,  INFECTION. 

By  Surg.  H.  R.  Carter. 


JULY,  1902. 


Whether  further  experimentation  is  desirable  before  we  accept  with- 
out reserve  the  Stegomyia  fasciata  contaminated  by  a  patient  sick  of 
yellow  fever  as  the  only  natural  means  of  conveying  yellow  fever  may 
be  a  question,  yet  I  think  that  the  argument  for  its  being  in  nature  con- 
veyed only  by  a  host,  and  doubtless  a  mosquito  host,  is  strong.  It  is 
assumed  that  there  is  no  question  that  it  may  be  thus  conveyed. 

1.  Analogy :  Of  such  diseases  as  have  been  fully  investigated,  all 
that  are  conveyed  from  living  hosts  are  caused  by  animal  parasites. 
Also  of  these  diseases  each  one  is  conveyed  {in  nature)  only  by  means  of  a 
host  of  a  given  genus. 

2.  Agreement  of  facts  observed  about  the  propagation  of  yellow 
fever  as  it  occurs  in  nature  with  the  necessary  deductions  from  the 
theory  of  conveyance  by  this  host. 

(a)  The  tact  that  the  disease  is  not  directly  propagated  from  the  sick  to 
the  well,  that  it  is  propagated  only  by  means  of  an  infected  environ- 
ment. 

(b)  That  a  man  sick  of  yellow  fever  may  infect  his  environment. 

(c)  The  existence  of  *' infectible"  and  "  noninfectible ' 7  territory,  (a) 

a  An  "infectible"  place  is  one  which,  if  cases  of  yellow  fever  be  introduced  therein, 
becomes  infected — i.  e.,  capable  of  inducing  yellow  fever  in  those  who,  susceptible  to 
that  disease,  visitor  live  there.  A  "noninfectible"  place  is  one  which  will  not  become 
infected  even  if  cases  of  yellow  fever  be  introduced.  In  such  a  place  yellow  fever  is 
not  a  transmissible  disease.  The  theory  of  conveyance  by  a  host  would  explain  the 
difference  by  the  presence  of  the  proper  host  (Stegomyia  fasciata)  in  the  one  and  its 
absence  in  the  other. 

4  sec.  c.  17 


Section  C. 


18 


(d)  The  relation  of  the  spread  of  the  disease  to  cold  weather,  altitude, 
and  excessive  dryness. 

(e)  The  close  correspondence  of  the  periods  of  incubation  observed 
after  one  exposure  to  infection  in  the  natural  way  (12  cases  observed 
by  myself)  with  the  periods  of  incubation  after  mosquito  inoculation 
by  Eeed — 12  cases  also.  Note  that  yellow  fever  caused  by  the  hypoder- 
matic injection  of  blood  or  strained  serum  from  a  yellow-fever  patient 
gave  neither  the  same  period  of  incubation  nor  the  same  interval  (/) — 
i.  e.,  this  is  not  a  natural  method  of  conveyance. 

(/)  The  existence  of  a  fairly  definite  interval  between  the  "infecting' ' 
and  "  secondary  "  cases  of  yellow  fever  in  its  development  in  an  envi- 
ronment. 

(g)  The  phenomenon  of  the  "extrinsic  incubation  of  places"  in 
house  infection  agreeing  with  the  time  Eeed  determines  must  elapse 
between  the  feeding  of  a  mosquito  on  a  yellow-fever  patient  and  tho 
time  it  is  able  to  communicate  the  disease  to  a  well  man.  This  is  a 
most  remarkable  phenomenon  and  with  (c)  is  scarcely  capable  of  any 
further  explanation  than  propagation  by  a  host,  (a) 

Qi)  Hybernation  of  yellow  fever  in  places  like  the  north  Gulf  coast 
and  Memphis,  where  mosquitoes  hybernate,  and  failure  to  hybernate  in 
subtropical  places  like  Key  West  and  Tampa,  where  mosquitoes  do  not 
hybernate. 

(i)  Conveyance  by  vessels,  etc.  In  the  same  way  the  method  of  con- 
veyance by  a  host  is  consonent  with  the  prolonged  and  yet  limited  per- 
sistence of  infection  in  places  (houses)  ;  with  the  well-known  influence 
of  aeration  as  freeing  a  place  from  infection  ;  with  the  habitual  convey- 
ance of  the  disease  short  distances  "down  the  wind  "  ;  with  the  compar- 
ative safety  of  "daylight  communication7'  with  an  infected  place,  etc. 

(j)  The  fact  that  the  Stegomyia  has  been  found  in  all  of  the  places 
known  to  be  usually  infectible  by  yellow  fever  which  have  been  exam- 
ined for  it,  should  also  be  noted.  That  it  is  evidently,  for  the  United 
States,  an  imported  insect  (although  now  acclimated)  and  has  been  con- 
veyed along  the  lines  of  railroads  and  great  rivers  well  agrees  with  the 
early  history  of  yellow  fever  in  the  United  States,  and  the  fact  that  yel- 
low fever  spreads  now  in  places  in  the  interior  which  m  past  years 
were  noninfectible.  Note  here  that  Las  Animas  (the  yellow-fever  hos- 
pital at  Havana)  was  certainly  not  infected  by  yellow  fever  in  1899  or 
to  July  15,  1900,  and  that  we  were  unable,  up  to  that  time,  to  find  any 


a  By  the  "extrinsic incubation"  of  yellow  fever  is  meant  4 4 the  time  that  elapses 
between  the  development  of  a  case  of  yellow  fever  in  an  uninfected  place  and  the  date 
at  which  that  place  becomes  capable  of  inducing  yellow  fever  in  those  who  are  exposed 
there."  This  the  writer  had  from  direct  observation  tentatively  fixed  at  44 usually  in 
excess  of  ten  days, "  44  the  usual  limits  being  from  ten  to  seventeen  days."  (Medical 
Record,  June  15,  1901,)  Reed  gives  the  minimum  time  between  the  date  of  feeding 
the  mosquito  on  the  yellow-fever  patient  and  the  date  at  which  yellow  fever  was  con- 
veyed by  the  same  insect  to  a  well  man  as  twelve  days. 


19 


Section  C 


of  the  "Finlay  mosquitoes"  there,  although  the  black  Gidex  was  in 
myriads.  It  is  but  fair  to  say  that  our  examination  was  not  a  complete 
one,  at  least  not  up  to  the  time  I  left  Havana,  July  23,  1900. 

(&)  Good  evidence,  too,  is  the  success  which  has  attended  the  institu- 
tion by  Gorgas  in  Havana  of  measures  for  the  suppression  of  yellow 
fever,  based  solely  on  this  theory  of  propagation,  and  which  would  be 
inefficient  against  an  ordinary  bacterial  disease  propagated  directly. 
If  the  result  in  1901  be  compared  with  the  failure  which  attended  the 
"campaigns  of  cleanliness"  and  general  disinfection  in  1899  and  1900, 
the  evidence  becomes  more  weighty.  Note  that  against  this  theory  can 
not  be  plead  that  yellow  fever  has  also  been  suppressed  or  controlled, 
which  has  occurred,  by  measures  not  directed  against  the  mosquito, 
because  such  measures  always  included  the  prompt  isolation  of  yellow- 
fever  cases  and  disinfection  with  sulphur  dioxide,  and  while  not  directed 
against  mosquitoes,  were  efficient  against  them. 

(I)  Now,  is  there  any  general  fact  established  about  yellow  fever 
which  is  incompatible  with  this  method  of  conveyance?  I  think  not. 
The  conveyance  by  fabrics  would  certainly  be  absolutely  against  this 
theory.  This  as  a  method  of  conveyance  used  to  be  generally  admitted, 
but  I  think  this  was  due  less  to  the  evidence  therefor  than  from  the 
analogy  of  other  infectious  diseases  and  because  (since  La  Roche)  the 
contrary  view  was  scarcely  advanced.  The  observation  on  Cuban  and 
Mexican  baggage  (see  a  quotation,  p.  5,  Bulletin  No.  6,  of  Sec.  C, 
Yellow  Fever  Institute)  are,  I  think,  sufficient  to  negative  the  method 
of  conveyance  by  baggage. 

Surg.  H.  R.  Carter,  of  the  Public  Health  and  Marine  Hospital  Service, 
*    *    *  writes: 

For  the  twenty  years  preceding  1899  the  baggage  from  Vera  Cruz,  Havana,  and 
Santiago  de  Cuba,  on  vessels  arriving  at  New  York,  unless  with  yellow  fever  en  route, 
entered  without  disinfection.  The  amount  of  this  baggage  from  Havana  and  Vera  Cruz 
La  large,  and  it  is  not  possible  bat  that  much  of  it  came  from  houses  infected  with 
yellow  fever  and  much  of  it  was  not  clean.  All  of  this  baggage  was  opened  at  the 
custom-house  at  New  York  and  handled  in  hotels  there  and  at  Saratoga,  and  no  yellow 
fever  is  reported  among  the  customs  inspectors  in  New  York,  or  at  the  hotels,  during 
this  time. 

The  baggage  going  from  the  same  ports  to  Spain  for  the  last  thirty  years  is  even  more 
to  be  considered.  Its  amount  has  been  enormous  ;  much  of  it  (from  the  class  of  people 
to  whom  it  belongs)  must  have  been  foul.  Some,  the  lesser  part,  it  is  true,  of  this 
traffic  goes  to  the  Mediterranean  ports  of  Spain — Valencia,  Malaga,  and  Barcelona, 
etc. — which  at  times,  1870  and  before,  have  been  "infectible  places,"  yet,  I  think,  we 
have  had  no  yellow  lever  reported  in  the  Peninsula  since  the  epidemic  of  1870. 

Of  course,  negative  evidence  is  convincing  only  in  proportion  to  its  mass,  and  that  a 
piece  of  baggage  or  100  pieces  of  baggage  from  an  infected  place  did  not  convey  infection 
to  nonimmunes  exposed  to  it,  means  little,  yet  the  amount  of  this  baggage  is  so  large — 
J  can  not  estimate  it  at  less  than  that  of  300,000  persons  from  Havana  alone— that  we 
must  claim  that  a  very  large  number  of  pieces  of  baggage  from  infected  houses  have 
been  introduced  into  New  York  and  Spanish  towns,  that  numbers  of  susceptible  people 
have  thus  been  exposed  under  various  conditions,  but  have  not  contracted  yellow  fever. 

To  me  the  mass  of  this  evidence  is  sufficient  to  be  convincing,  and  I  count  it  proven 


Section  C. 


20 


that  baggage  from  Havana  and  Vera  Cruz  will  not  convey  yellow  fever  directly  to  peo- 
ple after  the  voyage  to  New  York  or  Spain,  thus  that  yellow  fever  is  not  conveyed  by 
mosquitoes  carried  in  such  baggage. 

Whether  this  time  element  is  necessary,  of  course,  is  not  determined  by  these  observa- 
tions, but  it  is  a  factor  in  them. 

Whether  the  rare  cases  of  yellow  fever  we  sometimes  see  contracted  from  infection 
aboard  ship  hitherto  uninfected  may  be  due  to  infected  mosquitoes  brought  aboard  in 
the  hand  baggage  of  passengers,  and  opened  soon  after  coming  aboard,  may  be  a  ques- 
tion. The  sister  who  developed  yellow  fever  aboard  the  Vigilancia  en  route  from  New 
York  to  Havana,  is  a  case  in  point,  and  we  occasionally  see  members  of  the  crew  with 
yellow  fever.  One  occurred  in  Havana  harbor  on  a  Ward  liner  en  route  from  Vera  Cruz 
to  New  York  in  1900.    Other  explanations  of  these  cases  may,  of  course,  be  possible. 

With  the  above  should  have  been  considered  in  addition  from  175,000 
to  200, 000  persons,  troops,  and  families  returned  from  Cuba  by  transport 
at  the  end  of  the  war,  with  baggage  and  equipment.  As  to  the  positive 
instances  of  conveyance  by  baggage  which  have  been  reported,  none 
that  I  have  been  able  to  inquire  into  personally,  certainly  exclude  this 
method  of  conveyance.  The  reporter  begins  (as  I  did)  with  the  assump- 
tion that  yellow  fever  is  conveyed  by  fomites,  and  as  soon  as  he  can 
show  the  introduction  of  fomites  from  an  infected  place,  he  is  satisfied. 
He  looks  no  further  for  any  other  source  of  infection.  Strange  to  say, 
the  best  attested  cases  I  have  come  across  have  not  been  those  of  convey- 
ance by  packed  baggage,  but  by  clothing  worn  on  the  person,  sometimes  for 
a  number  of  miles,  or  hours  through  the  sun  and  air,  which  is  against 
all  other  experience  of  this  disease.  Of  the  older  reported  cases  I  have 
nothing  to  say  ;  I  can  not  examine  them  ;  only  as  none  of  the  modern 
ones  which  I  have  been  able  to  inquire  into  clearly  exclude  other  means 
of  conveyance,  it  is  fair  to  at  least  doubt  if  the  older  reports  are  impec- 
cable. Also  it  is  common  sense,  that  when  there  is  a  great  mass  of  nega- 
tive testimony  on  a  subject,  all  tending  one  way,  we  may  not  accept  a 
moderate  amount  of  positive  evidence  in  rebuttal  unless  its  data  be  con- 
clusive, and  I  think  the  evidence  of  the  Cuban  and  Mexican  baggage  is 
great  enough  for  this  rule  to  apply.  I  think  then  we  may  reject  the 
conveyance  by  fomites  as  not  proven,  and  say  that  there  is  no  good 
evidence  in  rebuttal  of  conveyance  save  by  a  host. 

Now,  let  us  look  at  this  evidence.  The  argument  from  analogy,  in 
this  case  has  great  weight.    The  presumption  that  it  creates  is  strong. 

For  the  second  argument.  It  is  indirect  evidence,  of  course,  yet  it 
is  the  kind  that  we  accept  for  the  theories  of  the  causation  of  other 
kinds  of  natural  phenomena.  That  the  deductions  from  the  theory 
agree  with  the  observations  of  the  phenomena  is  the  only  evidence  we 
have  for  the  doctrine  of  universal  gravitation,  of  the  vibration  of  light, 
of  the  conservation  of  energy,  etc.,  which  physicists  hold  as  beyond 
cavil.  It  is  true  we  have  been  able  to  apply  mathematics  to  these 
theories,  and  that  the  chain  of  phenomena  which  we  can  thus  compare 
is  much  greater  than  we  have  in  this  instance ;  yet  I  think  that  we 
can  fairly  claim  that  in  our  case  all  the  phenomena  which  we  have  fully 


21 


Section  C. 


examined  agree  with  the  deductions  from  the  theory  and  none  disagree, 
and  the  principle  of  deciding  on  the  truth  of  the  theory  is  the  same.  I 
think  then  that  the  evidence  (presumptive  only)  is  good,  that  the  only 
means  of  conveying  yellow  fever  is  by  means  of  a  mosquito  host. 

This  evidence  is  indirect  and  presumptive  only.  Yet  it  seems  easy 
to  obtain  some  direct,  although  negative,  evidence — i.  e.,  to  show  that 
other  methods  (besides  the  host)  do  not  convey  infection.  Could  we 
show  that  no  other  methods  ever  convey  infection  it  would  be  a 
demonstration. 

To  look  at  the  matter  broadly,  there  are  usually  three  atria  of  entrance 
of  an  infection  :  (1)  By  the  alimentary  canal ;  (2)  respiratory  tract,  and 
(3)  abraided  or  punctured  integument.  For  yellow  fever  the  first  is 
not  accused.  The  negative  evidence  against  conveyance  by  drinking 
water  is  overwhelming,  and  while  that  against  foods  is  less  so,  still  it  is 
great,  and  there  is  no  evidence  whatever  for  it  so  far  as  I  know,  and  no 
one  claims  it. 

To  exclude  the  second  one.  If  we  could  place  a  certain  number  of 
people  in  an  environment  infected  with  yellow  fever — i.  e.,  an  environ- 
ment in  which  cases  of  yellow  fever  were  being  contracted  (not  simply 
where  such  cases  existed),  living  in  all  respects  like  those  who  are  con- 
tracting the  disease,  but  protected  against  mosquitoes,  and  these  people 
should  fail  to  contract  the  fever,  it  would  be  evidence  that  the  single 
factor  present  in  the  case  of  those  contracting  the  fever,  but  absent  in 
their  own — i.  e.,  the  mosquitoes  puncturing  the  skins  of  one  set  and  not 
of  the  other,  was  the  cause  of  the  different  results  in  two  sets  of  people. 
I  say  "evidence,"  and  this  evidence  would  be  convincing  in  proportion 
to  (1)  the  degree  of  infection  of  the  premises  as  shown  by  the  propor- 
tion of  those  entering  them  who  contracted  the  disease  and  (2)  the 
number  of  susceptible  people  exposed  and  the  length  of  their  exposure. 
It  is  somewhat  strengthened  if  these  same  people  who  escape  afterward 
develop  fever  from  mosquito  inoculation;  but  this  is  not  necessary  if 
enough  people  are  subjected  to  the  experiment.  Such  evidence  would 
never,  strictly  speaking,  be  proof;  yet  could  such  an  experiment  be 
made  in  a  house  like  the  Grey  House,  at  Or  wood,  in  1898,  where  of 
32  people  who  entered  the  house,  some  only  to  stay  a  few  hours,  SI 
developed  yellow  fever  from  that  exposure,  the  exposure  of  a  very 
moderate  number  of  people,  not  immune  to  yellow  fever,  thus  isolated 
from  mosquitoes,  would  be  convincing  to  me.  I  can  conceive  of  no 
other  test  which  will  directly  show  that  conveyance  of  yellow  fever  does 
not  take  place  by  the  respiratory  tract. 

We  have  seen  that  the  theory  of  conveyance  by  a  host  explains  all 
the  facts  which  we  know  of  the  conveyance  of  yellow  fever.  Does  any 
other  theory  also  explain  them?  If  so,  it  also  has  a  right  to  be  con- 
sidered. 

It  is  proven  that  yellow  fever  is  not  in  nature  transmitted  directly 
from  the  sick  to  the  well.    It  is  propagated  from  the  sick  man  by  his 


Section  <'. 


infecting  his  environment,  from  which  only  is  it  contracted  by  others 
exposed  thereto.  This  is  nowise  in  accord  with  the  methods  of  con- 
veyance of  known  bacterial  diseases,  all  of  which  are  conveyed  by 
material  directly  from  the  patient  inhaled  or  injested  by,  or  (as  with 
leprosy)  applied  to  an  abraded  surface  of,  the  one  who  receives  the 
infection. 

From  this  it  is  a  necessary  deduction  that  the  disease  is  not  in  nature 
propagated  by  material  conveyed  directly  from  the  sick  to  the  well ; 
that  some  material  after  leaving  the  body  of  the  patient  undergoes  some 
change  outside  of  his  body,  and  after  this  change  produces  yellow  fever 
in  one  susceptible  to  that  disease. 

This  change,  which  takes  place  outside  of  the  body  of  the  sick  man, 
may  be : 

A.  A  change  in  physical  condition  of  the  excretion  containing  the 
microorganism  rendering  it  able  to  reach  the  proper  atrium  for  the 
infection  of  others.  Analogous  to  the  drying  and  pulverization  of 
tubercular  sputum,  etc. 

B.  The  infection  of  a  host,  by  which  host  (or  its  offspring)  the  micro- 
organism is  transmitted  analogous  to  the  transmission  of  malarial  fever 
or  the  Texas  fever  of  cattle.  This  may  involve  no  change  in  the  organ- 
ism itself.  It  may  simply  place  the  organism  in  a  position  to  enter  the 
human  organism  by  the  necessary  atrium,  as  directly  into  the  circula- 
tion or  lymph  spaces.    Of  course  it  does  not  negative  such  change. 

C.  A  change  in  the  microorganism  itself,  it  undergoing  development 
outside  of  the  human  body  into  some  stage  different  from  that  in  which 
it  leaves  the  body.  This  last  has  been  the  theory  accepted  by  most  of 
the  writers  who  have  considered  this  subject,  but  there  is  no  analogy 
with  the  propagation  of  any  other  disease,  so  far  as  is  known  to  the 
writer. 

No  other  hypothesis  is  to  me  conceivable. 

Also  it  is  proven  that  not  all  environments  become  infected — i.  e., 
capable  of  inducing  yellow  fever  in  those  exposed  in  them  by  the  pres- 
ence of  people  sick  of  yellow  fever ;  that  there  are  places  which  become, 
habitually  become,  infected  if  cases  of  yellow  fever  be  introduced  at 
certain  seasons  of  the  year  and  others  which  do  not  and  into  which  the 
introduction  of  such  cases  causes  no  infection  of  the  environment. 

Certain  conditions  of  the  environment,  then,  even  in  the  presence  of 
the  yellow-fever  patient,  are  necessary  for  it  to  become  infected.  Besides 
temperature,  moisture,  and  altitude,  there  are  others  of  which  we  are 
ignorant,  and  many  localities  habitually  have  not  received  infection 
from  the  presence  of  the  sick,  although  there  are  no  differences  in  soil 
or  climate,  which  we  could  appreciate,  between  these  localities  and 
others  that  did  so  become  infected. 

This  quality  of  a  place,  its  being  infectible  by  yellow  fever,  some- 
times, probably  frequently,  varies  from  year  to  year.  Cases  of  yellow 
fever  may  be  introduced  some  summers  with  impunity,  and  in  others  in 


23 


Section  C. 


the  same  place  spread  on  introduction.  Compare  the  results  at  Fer- 
nandina  in  1876  and  1877. 

Now,  of  the  three  hyposeses,  A,  B,  and  C,  the  first  is,  I  think,  not 
compatible  with  what  is  known  of  the  infectibility  of  places,  and  which 
is  so  well  known  that  we  have  only  alluded  to  it  above.  It  is  not 
reasonable  that  the  conditions  which  determine  the  physical  condition 
of  the  infective  material  should  be  those  that  we  know  to  influence  the 
infectibility  of  places,  or  that  they  should  be  so  elusive  to  meteorolog- 
ical tests  as  the  latter  have  proven. 

The  third  is  negatived  by  the  proven  fact  (Reed  and  Carroll)  that  the 
blood  or  serum  of  a  yellow-fever  patient  injected  hypodermatically  into 
a  well  man  will  produce  the  disease  in  him.  The  microorganism  then 
exists  in  the  blood  of  the  patient,  and  consequently  in  the  bloody  mate- 
rial extruded  from  him  (gums,  etc.)  in  a  form  capable  of  producing 
the  disease.  No  change  of  development  is  necessary  if  it  can  only  be 
introduced  into  the  circulation  directly. 

The  second  hypothesis  of  the  three,  which  alone  seemed  admissible, 
is  then  the  only  one  not  incompatible  with  the  facts  which  we  know  of 
the  propogation  of  yellow  fever,  and  we  have  seen  previously  that  it  is 
entirely  compatible  with  them. 

To  sum  up  : 

For  the  belief  that  yellow  fever  is  conveyed  in  nature  only  by  a  host 
and  doubtless  a  mosquito  host,  we  have — 

1.  The  analogy  of  other  diseases  conveyed  by  insect  hosts. 

2.  That  all  facts  observed  about  the  propagation  of  yellow  fever  agree 
with  the  necessary  deductions  of  this  theory. 

3.  No  other  theory  explains  all  the  facts  observed  of  its  propagation. 
The  second  postulate,  may  be,  I  think  should  be  tested  further  by  the 

collection  of  other  facts  to  be  compared  with  the  theory  ;  possibly  on 
the  lines  given  above,  for  obtaining  direct  negative  evidence  about  this 
theory  of  conveyance.  Yet  the  evidence  already  extant  seems  to  the 
writer  convincing  and  he  is  convinced  that  yellow  fever  is  conveyed  in 
nature  only  by  a  mosquito  host  of  a  particular  kind  or  kinds. 


5  sec.  c. 


FEVER  INSTITUTE,  BULLETIN  No.  1  1 

easury  Department,  Public  Health  and  Marine- Hospital  Service. 

WALTER  WYMAN,  Surgeon-General. 


VESSELS  AS  CAERIERS  OF 
MOSQUITOES, 


BY 


Passed  Asst.  Surg.  S.  B.  GRUBBS. 


MARCH,  L903. 


WASHINGTON:  °^4fct/fc 

GOVERNMENT  PRINTING  OFFICE. 
1903. 

STATE  UNIVERSITY,  i<^9jj^ 


YELLOW  FEVER  INSTITUTE,  BULLETIN"  No.  11. 

Treasury  Department,  Public  Health  and  Marine-Hospital  Service. 

WALTER  WYMAN,  Surgeon-General. 


VESSELS  AS  CARRIERS  OF 
MOSQUITOES, 

BY 

Passed  Asst.  Surg.  S.  B.  GRUBBS. 


MARCH,  1903. 


WASHINGTON: 

GOVERNMENT  PRINTING  OFFICE. 

1  9  0  3 . 


YELLOW  FEVER  INSTITUTE. 

Treasury  Department,  Bureau  of  Public  Health  and  Marine-Hospital  Service. 
WALTER  WYMAN,  Surgeon-Ueneral. 

Bulletin  No.  11. 
Section  C. — TRANSMISSION.  Asst.  Surg.  Gen.  J.  H.  WHITE,  Chairman  of  Section. 


VESSELS  AS  CARRIERS  OF  MOSQUITOES. 

By  S.  B.  Grubbs, 

Passed  Assistant  Surgeon,  United  States  Public  Health  and  Marine- Hospital  Service. 

At  the  present  time,  when  evidence  is  pointing  with  more  and  more 
clearness  to  the  mosquito  as  the  sole  means  of  transmitting  yellow 
fever,  nothing  is  of  greater  interest  to  the  quarantine  officer  than  to 
decide  to  what  extent  and  under  what  circumstances  these  infecting 
insects  may  be  carried  by  vessels. 

This  subject  may  be  approached  in  three  different  ways:  First,  by 
observations  on  the  length  of  time  after  leaving  infected  ports  vessels 
may  develop  yellow  fever;  second,  by  experiments  with  mosquitoes 
under  artificial  conditions  made  to  simulate  as  much  as  possible  those 
of  nature;  and  third,  by  actual  observation  of  vessels  arriving  from 
ports  at  the  time  infected  or  where  the  presence  of  the  Stegomyia 
fasciata  render  them  liable  to  infection. 

While  it  will  require  data  obtained  by  all  these  means  and  extend- 
ing over  a  long  period  to  arrive  at  any  conclusions  sufficiently  accurate 
to  allow  them  to  influence  quarantine  procedure,  still  I  believe  the 
last  method  of  observation  cited  will  throw  more  light  on  the  subject 
than  the  first  two. 

It  is  for  this  reason  that  every  vessel  arriving  at  Gulf  Quarantine 
Station  from  Stegomyia-infected  ports  has,  since  the  1st  of  July  last, 
been  carefully  examined  to  ascertain  if  mosquitoes  were  present  on 
board,  and,  if  present,  their  variety,  where  and  when  they  came 
aboard,  and  under  what  conditions. 

Gulf  Quarantine  Station  is  an  especially  good  point  for  these 
observations,  from  the  fact  that  it  is  10  miles  from  the  mainland,  and 
because  vessels  bound  here  do  not  pass  near  land,  and  so  but  rarely 
take  on  mosquitoes  en  route,  and  even  these,  as  will  be  seen,  are 

25 


26 


always  the  marsh-bred  varieties  of  Cidex.  Besides,  the  examination 
of  at  least  a  thousand  mosquitoes  on  Ship  Island  has  convinced  me 
that  there  arc  no  Stegomyia  here. 

Each  vessel  inspected  was  carefully  searched,  the  inspector  being 
armed  with  a  cyanide  killing  bottle,  and  in  addition  the  captain  was 
asked  the  following  questions: 

1.  Were  there  any  mosquitoes  on  board  on  your  outward  voyage, 
consisting  of  days? 

2.  If  so,  did  they  come  aboard  before  departure  from  home  port  or 
at  sea,  and  under  what  circumstances? 

3.  Were  there  any  mosquitoes  on  board  at  your  destination  or  on 
homeward  voyage? 

4.  If  in  port — 

(a)  How  far  were  you  from  shore  ? 

(b)  Prevailing  wind  and  weather? 

5.  If  on  homeward  voyage  (consisting  of  days) — 

(a)  Were  they  from  port? 

(b)  Did  they  come  aboard  at  sea,  on  what  day,  and  how  far  were  you 
from  land  ? 

(c)  Were  there  wigglers  in  an}^  of  your  tanks  at  any  time? 
During  the  five  months  from  June  1  to  November  1  observations 

were  made  on  82  vessels,  all  arriving  from  ports  where  the  Stegomyia 
is  believed  to  exist  in  quantities.  Of  these  78  were  sailing  vessels 
and  4  were  steamers. 

Of  these  82  vessels  65  claimed  to  have  had  no  mosquitoes  aboard  at 
any  time  during  the  voyage  or  at  port  of  departure,  and  their  absence 
having  been  confirmed  by  search,  we  can  dismiss  them  from  consider- 
ation and  pass  to  the  remaining  17. 

Five  of  these  had  mosquitoes  on  board  at  their  ports  of  departure, 
2  being  rid  of  them  as  soon  as  they  were  well  at  sea,  while  3  others 
carried  them  two  days  and  were  then  no  more  troubled,  except  one 
schooner  on  which  they  reappeared  in  quantities  five  days  before  she 
reached  this  port,  when  she  was  20  miles  from  shore. 

Nine  sailing  vessels,  having  no  mosquitoes  on  board  before  sailing, 
had  them  appear  at  sea,  in  one  case  from  the  water  casks  in  which  the 
captain  found  larva?.  But  in  the  other  cases  they  doubtless  came  from 
land  which  was  at  the  time  distant — 20  miles  in  one  case,  15  miles  in  » 
three  cases,  10  miles  in  one  case,  and  2  miles  in  the  last  two  instances. 
In  all  these  vessels  the  mosquitoes  found  on  board  on  arrival  at  this 
station  were  the  common  varieties  of  Culex,  there  being  no  Anopheles 
or  Stegomyia  among  them. 

Stegomyia  fasciata  were  found  on  board  and  were  identified  in  the 
remaining  three  cases,  as  follows: 

The  schooner  Susie  B.  Dantzler  arrived  from  Vera  Cruz,  Mexico, 
on  July  16,  1902,  after  a  voyage  of  fifteen  days.    The  captain  stated 


27 


that  mosquitoes  came  aboard  in  large  quantities  at  Vera  Cruz,  although 
he  lay  a  half  mile  from  shore  and  there  were  variable  winds  with 
j  squalls  and  rain  all  the  time.  The  number  of  the  insects  decreased  on 
the  voyage  but  were  always  in  evidence,  and  we  caught  four  or  five  of 
them  here.  No  larva?  were  found  in  any  of  the  tanks,  and  as  the  cap- 
tain had  repeatedly  examined  them  without  result  in  his  efforts  to  be 
rid  of  the  mosquitoes,  I  believe  the  insects  found  on  board  here  came 
all  the  way  from  Vera  Cruz. 

The  schooner  Eleanor  arrived  from  Vera  Cruz  on  July  17,  1902, 
thirteen  days  out.  She  had  no  mosquitoes  on  board  before  reaching 
Vera  Cruz,  but  there  quantities  came  on  board.  Her  moorings  were 
half  a  mile  from  shore  and  the  winds  were  variable.  The  captain 
stated  that  he  could  not  get  rid  of  the  insects  after  sailing,  although 
the  number  decreased  very  much  and  there  were  no  larva?  in  any  of 
the  tanks.  At  the  time  of  her  inspection  here  we  caught  and  identi- 
fied a  number  of  Stegomyia. 

The  brigantine  John  H.  Crandon  arrived  at  the  station  July  27, 
1902,  twenty-two  days  from  Vera  Cruz,  where  she  had  one  case  of 
yellow  fever  on  board.  At  that  port  she  lay  a  half  mile  from  the  sea 
wall,  three-eighths  of  a  mile  from  an  infected  prison,  and  within  200 
yards  of  an  infected  vessel.  Stegomyia  fasciata  were  found  on  board 
by  Acting  Assistant  Surgeon  Hodgson  before  she  sailed,  as  well  as 
larva?  in  the  tanks.  All  during  the  trip  there  were  mosquitoes  in 
abundance,  and  a  veritable  plague  of  Stegomyia  was  found  on  board 
on  her  arrival  here.  There  was  a  constant  buzz  in  the  forecastle,  and 
anyone  entering  was  sure  to  be  attacked  by-  several  mosquitoes.  Spec- 
imens were  caught  in  almost  every  protected  part  of  the  vessel,  and 
all  were  found  to  be  the  Stegomyia  fasciata.  The  captain  had  emptied 
several  water  barrels  because  he  found  they  were  breeding  mosqui- 
toes, but  the  water  remaining  had  no  live  larva?,  although  many  old 
moults  were  seen.  As  breeding  was  surely  going  on  in  the  tanks  dur- 
ing a  part  of  the  voyage  at  least,  it  would  be  impossible  to  say  how 
long  any  particular  mosquito  had  been  aboard  or  if  any  of  them  had 
been  brought  here  from  the  infected  port. 


SUMMARY. 

The  above  facts  may  be  summed  up  as  follows: 

Vesssels  having  no  mosquitoes  on  board  at  any  time   65 

Vessels  having  mosquitoes  on  board  in  port  of  departure   5 

Vessels  on  which  mosquitoes  {Culex)  appeared  en  route   9 

Vessels  arriving  with  Stegomyia  fasciata  on  board   3 

Three  and  a  half  per  cent,  then,  of  all  vessels  brought  Stegomyia 
on  a  voyage  averaging  seventeen  days. 


28 


CONCLUSIONS. 

From  but  one  season's  observations  at  a  single  quarantine  station 
we  can  not  assume  to  draw  any  hard  and  fast  conclusions  regarding 
the  probability  of  Stegomyia,  infected  or  not,  being  carried  by  vessels. 
Nevertheless,  I  think  we  may  conclude,  first,  that  mosquitoes  can  come 
aboard  vessels  under  favorable  conditions  when  the  vessel  is  not  over 
15  miles  from  shore;  second,  that  Stegontyia  can  be  carried  from 
Mexican  or  West  Indian  ports  to  those  of  our  Gulf  States;  third,  that 
they  can  board  a  vessel  lying  at  anchor  a  half  mile  or  less  from  shore, 
being  conveyed  by  the  open  lighters  used  or  flying  aboard,  and  finally, 
that  a  vessel  moored  a  short  distance  from  land  may  become  infected 
with  yellow  fever,  our  old  beliefs  to  the  contrary  notwithstanding. 

1  wish  to  acknowledge  the  aid  of  Assistant  Surgeons  Burkhalter 
and  Ebersole  in  collecting  data  and  specimens. 


O 


